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Time Line Treatment of Pain

Alternative Fascinating Case History

Time Line Treatment of Pain

By
Dollie Mercedes
PhD, DD, MBA, Master Practitioner NLPtm,
Trainer EduKtm, Dx Thought Field Therapy,
Board Certified Professional Counselor,
American Psychotherapy Association

Productive Transitions
503-310-1872
DOLL450SL@GMAIL.COM
FEARFREE.BIZ
Santa Rosa. California

In integrative healing, there are many modalities.  Some techniques speak to certain individuals, and other techniques serve others.

I have used Neuro Linguistic Programming, NLPtm for many years along with several other energy techniques and found effective results.  In certain cases, I used an advanced NLPtm technique called Time Line Therapytm. (Developers discussed the process in their book, Time Line Therapy and the Basis of Personality, James & Woodsmall, 1988.)

Indicators that one should use this technique are that a patient’s problem has been long-term and does not seem to connect to an obvious trauma or event that would explain his or her discomfort.  Several cases have involved unexplained physical pain.  One of the more dramatic cases follows.

In the spring of 1987, a young man in his 30s was referred to me by his mother.  He had had “head pain” all his life.  All examinations had found no trace of any physical cause.  After the intake and probing questions, I chose to use the time line process.  As stated, there seemed to be no obvious cause that he or the family could recall.  His mother had cued me that this condition existed all his life, and the family had consulted medical personnel to examine him with no cause or solution found.

The first step is to find out how the client perceives the time relationship in his/her life.  I ask questions to determine where (in what direction) the thoughts of past and present seem to come from.  Most often, the past comes from behind and the present moves toward the front.  In other cases, the past may be toward the left, etc.  The key to this process is rationalizing some key event – that is, take the emotional hook out of it – as a way of neutralizing the memory.

After establishing the patient’s time line in his mind, I guided him to travel above the line toward his past until he was aware of the very first time some emotional event happened to cause the head pain.  One of the first questions I ask when guiding a client is, “Was the very first time before, during, or after your birth into this life?”

The patient’s head was bowed, his eyes open.  His mouth said “before,” but no sound came out.  When asked a second time, with the instructions to take whatever came up, he again mouthed the word “before.”  Finally, he spoke it out loud.  When I probed, he told me it was three lifetimes ago.

When I asked him to describe from above what he saw (I do not see things for others, they see and describe what they experience), he described a scene from his death in one of those former lifetimes wherein he was being scalped.

I guided the process down through the clearing process and brought it up and forward above his time line to the present, and then onward into the future.  Then I instructed him to return to the present and “be here now.”

The next day, his mother asked how the appointment went.  He said, “I don’t know if I believed that stuff.”  After his mother asked about the head pain, he responded, “It’s gone.”

His mother commented, “Does it matter whether you believe it or not?”

There is no head pain to this day.


Treatment for Survivors of Natural Disasters

Treatment for Survivors of Natural Disasters

Lauren T. Bradel, MA
Northern Illinois University
Kathryn M. Bell, PhD
Capital University

Correspondence: Lauren T. Bradel, MA, Department of Psychology, Northern Illinois University, DeKalb, IL 60115. Email: ltbradel@gmail.com. Phone: 218-760-3387.
Correspondence: Kathryn M. Bell, PhD, Assistant Professor, Psychology Department, Capital University, Columbus, OH 43209. Email: kbell626@capital.edu. Phone: 614-236-6439.

Abstract

Natural disasters such as floods, earthquakes, tornadoes, and hurricanes can lead to significant psychological (and physical) impairment in populations both directly and indirectly exposed to the disaster. Although not everyone who survives a natural disaster responds aversively, a relatively large number of people do. In adults, stress reactions following a natural disaster may range from heightened anxiety and an increase in the frequency of nightmares to debilitating post-traumatic stress and severe depression. Of individuals exhibiting severe aversive reactions to natural disasters, many fail to utilize available mental health care services for one reason or another. Treatment approaches and strategies for enhancing treatment utilization among natural disaster survivors are discussed.

Keywords: trauma, natural disaster, PTSD, treatment

Learning Objectives:
1. Raise the audience’s awareness of psychological problems commonly experienced by natural disaster survivors
2. Increase the audience’s knowledge of factors related to the development of psychopathology following natural disasters
3. Improve the audience’s understanding of treatment barriers for natural disaster survivors and provide suggestions for overcoming these barriers
4. Enhance the audience’s understanding of evidence-based approaches to treating survivors of natural disasters

Program Level: Beginners

Prerequisites: None

Target Audience:
Psychologists who currently work with or may in the future work with survivors of natural disasters According to the National Comorbidity Survey, nearly 19% of men and 15% of women report having experienced a natural disaster, or naturally-occurring catastrophe that is not man-made, at some point during their lifetimes (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Research has indicated that, for survivors, natural disasters tend to result in slightly fewer negative psychological outcomes than man-made disasters, such as plane crashes and acts of terrorism (David et al., 1996). In spite of this, natural disasters have been shown to lead to significant psychological impairment in adult survivors. Multiple studies have shown an increase in psychopathology following natural disasters that may linger for years following the event (Boe, Holgersen, & Holen, 2010; van Griensven et al., 2006).

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Psychopathology Following a Natural Disaster

PTSD

Post-traumatic stress disorder (PTSD) and posttraumatic stress symptoms have been shown to be one of the most prominent psychological conditions to develop following a natural disaster (David et al., 1996; Mason, Andrews, & Upton, 2010; Schoenbaum et al., 2009). PTSD and posttraumatic stress symptoms can result from exposure to a traumatic event and cause significant distress or impairment. PTSD is characterized by the development of intrusive recollections of the event, avoidance of stimuli associated with the event, and hyperarousal that persist for more than one month (American Psychiatric Association [APA], 2000).

Prevalence rates of PTSD and posttraumatic stress symptoms following a natural disaster vary across a number of studies. In a study by Tobin and Ollenburger (1996) , survivors of a flood were interviewed by telephone approximately four months after the natural disaster occurred. Nearly 71% of survivors reported experiencing some posttraumatic stress symptoms, with 25% of survivors reporting a high level of posttraumatic stress symptoms. Additional studies have also shown that individuals with preexisting psychological disorders may be at an increased risk for developing PTSD or posttraumatic stress symptoms following a natural disaster (Boe et al., 2010; McMillen, North, Mosley, & Smith 2002; Tobin & Ollenburger, 1996).

Depression

Research indicates that major depression often accompanies posttraumatic stress symptoms in survivors of natural disasters (McFarlane & Papay, 1992; North, Kawasaki, Spitznagel, & Hong, 2004). In a study conducted by Başoğlu, Kiliç, Şalcioğlu, and Livanou (2004), 16% of survivors who were at the epicenter of an earthquake in Turkey met diagnostic criteria for comorbid PTSD and depression. Ruminating, or constantly turning something over in one’s mind, related to symptoms of depression and posttraumatic stress has also been shown to increase the likelihood of developing depression following a natural disaster (Nolen-Hoeksema & Morrow, 1991). McLeish and Del Ben (2008) found that one month after Hurricane Katrina, depression scores in an outpatient population significantly increased, but PTSD scores remained unchanged.

Anxiety

Anxiety is another common psychological outcome following natural disasters, and it can come in several forms. In studying earthquake survivors in Turkey, Karanci and Rustemli (1995) found that survivors experienced a range of anxiety varying between phobic anxiety, somatization, and hostility, and many individuals’ symptoms were still chronic at a 16 month follow-up. Likewise, McFarlane and Papay (1992) found that survivors of a natural disaster experienced the development of both phobias and panic disorders following the event. Further, individuals suffering from high levels of general anxiety prior to the disaster were at an increased risk for experiencing higher-than-normal levels of post-disaster anxiety (Tobin & Ollenburger, 1996).

Substance Use

To date, research is inconclusive regarding how substance use changes in survivors of natural disasters, although many studies indicate that, as a whole, general substance use increases. For example, Parslow and Jorm (2006) found that survivors of a major bushfire in Australia significantly increased their tobacco use following the disaster—regardless of posttraumatic stress symptomology. Conversely, Beaudoin (2011) found that alcohol use following Hurricane Katrina significantly increased, but tobacco use did not. Beaudoin hypothesized that tobacco use did not increase because of the recent emphasis on publicizing tobacco’s adverse effects. In a third study, North and colleagues (2004) found no significant differences in pre- and post-disaster alcohol use in a sample of male flood survivors.

Although findings relating to natural disasters and substance use are relatively inconclusive, an abundance of research has supported the idea that surviving a traumatic experience, in general, is significantly related to increased substance use (Fetzner, McMillian, Sareen, & Asmundson, 2011; Khoury, Tang, Bradley, Cubells, & Ressler, 2010). Furthermore, Jacobsen, Southwick, and Kosten (2001) found that a diagnosis of PTSD often predicts substance use in trauma survivors. In a sample of individuals who had survived various traumatic experiences, Breslau, Davis, and Schultz (2003) did not find that PTSD preceded trauma survivors’ substance use, but they found that individuals did significantly increase nicotine use following the traumatic event. The authors hypothesized that PTSD and substance use disorders may be influenced by shared risk factors—other than trauma exposure—and this is why increased drug and alcohol use were not found to increase after the trauma.

Correlates of Psychopathology Following a Natural Disaster

Exposure

Several factors have been shown to influence the impact natural disasters have on an individual. Exposure to the disaster may be one of the most important risk factors for developing posttraumatic stress reactions (Kessler, Galea, & Jones,2006). Multiple studies have shown that the greater the degree of exposure to a natural disaster, the more likely the development of negative mental health outcomes (Galea, Nandi & Vlahov, 2005; Nolen-Hoeksema & Morrow 1991; Rhodes et al., 2010; Thompson, Norris, & Hanacek, 1993). In a study focused on earthquake survivors, Bland, O’Leary, Farinaro, Jossa, and Trevisan (1996) found that individuals’ psychological outcomes were directly positively correlated to the magnitude of personal consequences relating to the earthquake.

Likewise, several studies have indicated that relocation is related to negative psychological outcomes. Weems and colleagues (2007) found that individuals needing to evacuate during Hurricane Katrina exhibited significantly more posttraumatic stress symptoms than those who did not relocate. Similarly, in a study conducted in the United Kingdom, Mason, Andrews, and Upton (2010) found that having to relocate following a natural disaster, in addition to suffering high levels of exposure to the disaster, was a significant predictor of the development of psychopathology. Specifically, individuals needing to vacate their homes were, on average, two times more likely to meet diagnostic criteria for PTSD, anxiety, and/or depression. Davis, Grills-Taquechel, and Ollendick (2010) report similar findings, noting that individuals displaced by Hurricane Katrina experienced significantly higher levels of psychopathology than non-displaced individuals. In fact, they found housing to be one of the top stressors related to the hurricane.

Loss may also play a role in the development of mental health problems following the disaster. For example, loss, in general, has been shown to be significantly related to an increased likelihood of suffering negative mental health outcomes (Mason et al., 2010). Similarly, in a study looking at flood victims, Tobin and Ollenburger (1996) found that temporary or permanent loss of employment due to the flood was significantly related to individuals experiencing increased levels of stress. Death of a loved one during the natural disaster was also shown to increase stress levels. Research following Hurricane Katrina also showed that watching exposure to the hurricane in the form of excessively watching television coverage of the disaster and a loss of electricity were predictive of negative psychological outcomes (McLeish & Del Ben, 2008).

Social Support

Social support has been shown to be an important factor influencing the development of stress related to natural disasters (Galea et al., 2005; Lowe, Chan, & Rhodes, 2010). Kwon, Maruyama, & Morimoto (2001) found that low social support is associated with a higher likelihood of developing PTSD following a natural disaster. They also found that individuals perceiving greater social support prior to the disaster experienced less psychological distress, experienced fewer stressors, and perceived more social support following the natural disaster which, in turn, was related to lower post-disaster psychological distress. Subsequent to Hurricane Katrina, multiple studies reported that a high level of perceived pre-disaster support, emotional support throughout the disaster, and post-disaster companionship provided through sources such as churches and community centers were all predictive of fewer negative psychological outcomes as compared to individuals who did not receive those types of support (Ruggiero et al., 2009; Weems et al., 2007).

Preexisting Health Conditions

Natural disaster survivors with a prior history of trauma exposure or preexisting psychological condition may be more likely to develop PTSD than those with no preexisting trauma history or psychological condition (McMillen et al., 2002). For example, in a study conducted in the United Kingdom, flood survivors who had experienced a prior flood were at an increased risk of developing symptoms of posttraumatic stress and anxiety (Mason et al., 2010). The authors surmised that this relationship between prior disaster exposure and psychopathology may have been the result of the propensity of survivors to fear the reoccurrence of another exposure, and therefore, resulted in increased anxiety. Likewise, natural disasters can exacerbate pre-existing psychiatric symptoms and may also trigger the development of additional symptoms, such of depressive symptoms (McLeish & Del Ben, 2008; Schoenbaum et al., 2009). Similarly, individuals with poor physical health prior to the disaster may be as much as two to four times more likely to meet diagnostic criteria for PTSD, anxiety, or depression following exposure to a natural disaster than someone who was physically healthy prior to the disaster (Mason et al., 2010).

Individual Characteristics

Gender has also been shown to be associated with the likelihood of developing stress reactions to a natural disaster, including PTSD. Mason and colleagues (2010) found that, on average, female survivors of natural disasters scored higher on PTSD, anxiety, and depression scales than male survivors. Preliminary research suggests that low-income single mothers may be particularly vulnerable to the development of stress reactions (Lowe et al., 2010). Studies have also shown that factors such as neuroticism, guilt, problems with concentration, and obsessive traits are directly positively related to the development of PTSD following exposure to a natural disaster (Carr et al., 1997; Chen et al., 2001; Kuo et al., 2003; McFarlane, 1988).

Interpretation

The tendency to interpret a disaster in a negative way has been shown to be related to negative psychological outcomes (Tobin & Ollenburger, 1996). In a study looking at risk and resiliency factors following a hurricane, Lowe and colleagues (2010) found that individuals who appraised the disaster negatively were at an increased risk for negative psychological outcomes following the disaster than those who did not evaluate the hurricane as negatively. In fact, appraisals of the event were stronger predictors of posttraumatic stress than exposure to the disaster itself. Similarly, Ruggiero et al. (2009) found that, in individuals affected by the 2004 Florida hurricanes, extreme fear during the hurricanes was a strong predictor of individuals’ overall health.

Suicide

Notably, suicide is not among the prevalent psychological consequences of natural disasters. Research has shown that, although psychological distress may increase following a disaster, suicide rates do not necessarily increase as well (Kessler et al., 2006). For example, Krug et al. (1999) tracked suicide rates in various countries affected by natural disasters and found relatively no change in suicide rates. Similarly, Kessler et al. (2006) found that suicidality (ideation and suicide plans, but not attempts) was actually lower following Hurricane Katrina than before. Findings such as these suggest that factors other than just trauma exposure and psychopathology may play a role in individuals’ decisions to commit suicide. In fact, research on man-made disasters suggests that some aspects of post-disaster personal growth may actually be beneficial and protect against suicide in individuals with a clinically significant mental illness (Mezuk et al., 2009). Future research is needed to examine post-disaster personal growth and its impact on suicide risk among individuals exposed to natural disasters.

Factors Related to Treatment

Treatment Utilization

Few studies have been conducted looking at mental health service use following natural disasters. Most existent research looking at treatment utilization focuses on service use following Hurricane Katrina. For example, in a telephone survey of Hurricane Katrina survivors by Wang and colleagues (2007), only 16% of respondents had used mental health services following the hurricane. Furthermore, only 4% of respondents were currently seeing a mental health professional whereas 11% were regularly visiting a general medical practitioner. In another telephone study, Wang and researchers (2008) found that 23% of respondents with preexisting mental health issues who used mental health services prior to the hurricane had either reduced or terminated treatment after Katrina. Of those individuals receiving treatment after the hurricane, nearly 65% were being treated by a general medical practitioner as opposed to a mental health professional. Polusny and colleagues (2008) report similar findings with tornado survivors, noting that participants were significantly more likely to seek treatment from a general medical practitioner than a mental health care professional.

Wang and colleagues (2007) report a dropout rate for psychotherapy of nearly 60% following Hurricane Katrina. Of those who sought treatment but discontinued, the authors found that drop out was for a number of reasons including financial limitations (22%); lack of enabling factors, such as transportation (42%); feeling their psychological concerns were not severe enough to justify seeking treatment (50%); and feeling as though their psychological concerns would resolve naturally over the course of time (52%). In a study of individuals with at least five symptoms of depression, Nutting, Rost, Smith, Werner, and Eliot (2000) reported similar findings with 57% of participants beginning treatment but only 17% completing treatment. Dissimilar to Wang and colleagues (2007), Nutting et al. (2000) attributed the high drop-out rate to severe physical problems that, likely, detracted from individuals’ interest in seeing treatment of psychological concerns.

Characteristics Influencing Healthcare Utilization Following a Natural Disaster

Various demographic variables have been shown to be related to the mental health services individuals receive following a natural disaster, including Hurricane Katrina. Studies looking at correlates of healthcare utilization following natural disasters have found that women are significantly more likely to seek services than their male counterparts (Rosen, Matthieu, & Norris, 2009; Roy-Byrne, Joesch, Wang, & Kessler, 2009; Wang et al., 2007; Wang et al., 2008). Furthermore, being a member of a minority group is related to significantly less healthcare use than White individuals, and being a member of a minority group has also been shown to be a significant predictor of treatment drop-out (Roy-Byrne et al., 2009; Wang et al., 2007). Multiple studies show that individuals who are middle-aged are the most likely age group to receive healthcare services following a natural disaster; the elderly and children are the least likely to receive proper healthcare (Rosen et al., 2009; Roy-Byrne et al., 2009; Wang, 2007). Additionally, individuals who are married, currently co-inhabiting with a partner, or have been married at some point in life are more likely to seek healthcare services than individuals who do not fall into one of those categories (Roy-Byrne et al., 2009; Wang et al., 2007).

Education and socioeconomic status are also significant predictors of healthcare service utilization after a natural disaster. Roy-Byrne and colleagues (2009) found that following Hurricane Katrina, individuals with a high school education and below were less likely to receive adequate healthcare services than those with more extensive education. Similarly, individuals with modest incomes prior to the hurricane were less likely to receive healthcare services than individuals with extremely low incomes or more substantial incomes (Roy-Byrne et al., 2009; Wang et al., 2007). Also related to education and income, individuals with no health insurance were less likely to receive healthcare than individuals who had coverage (Wang et al., 2007; Wang et al., 2008).

Research exploring pre-disaster health as a potential predictor of who will receive healthcare services—and specifically, physician referrals—following a natural disaster has been inconclusive. In a study by Rosen and colleagues (2009), results indicated that individuals who experienced significant disaster-related loss were more likely than those who had not experienced a significant disaster-related loss to receive referrals for healthcare services. Likewise, individuals who suffered from a disability prior to the natural disaster are often more likely to receive a referral than individuals who did not have a prior disability (Rosen et al., 2009). Conversely, Rosen and researchers (2009) found that individuals suffering from pre-disaster mental illness were less likely to receive a referral for post-disaster assistance than individuals not previously suffering from a mental illness.

Enabling resources are also important factors in determining whether or not individuals seek healthcare services after a disaster. Facilities must be available, individuals need access to transportation to make use of available services, travel times must be reasonable, and potential clients need to have the knowledge of how to use the services available to them (Wang et al., 2008). Given the risk for resource loss during a natural disaster (e.g., loss of electricity, telecommunications, transportation), it is no wonder that some survivors are unaware of available resources and/or may not have the means to access these resources even though they might otherwise be interested in utilizing these resources.

Not only do demographic variables and resources predict healthcare utilization, but attitudes towards healthcare services are also a significant predictor of use following a natural disaster. Low perceived need, or the belief that symptoms will diminish over time, is a common factor that prevents individuals from seeking post-disaster services (Wang et al., 2007; Wang et al., 2008). Similarly, individuals’ perceptions of their own symptoms and how they are still able to function may influence if they judge their problems as severe enough to require help from a mental health professional (Polusny et al., 2008). Stigma and the belief that treatment is useless—although this belief is less common than low perceived need—are other reasons that individuals may avoid seeking healthcare services after a disaster (Wang et al., 2007; Wang et al., 2008).

Specific psychiatric symptoms may also influence one’s decision to seek treatment and from whom they seek that treatment. For example, individuals suffering from PTSD Cluster C (avoidance) symptoms are more likely to use post-disaster healthcare than individuals suffering from other posttraumatic stress symptoms (Polusny et al., 2008). Findings also indicate that individuals may be more likely to seek services from a general practitioner rather than a mental health provider following exposure to natural disaster. Researchers from this study hypothesized that survivors experiencing a greater number of PTSD avoidance symptoms may avoid mental healthcare because they fear treatment will focus on the traumatic event (Polusny et al., 2008).

Current Treatment Methods

Critical Incident Stress Debriefing

Critical Incident Stress Debriefing (CISD), a group-based method of psychological debriefing (PD), has become common practice following various types of traumatic events. The goal of CISD is, generally, to minimize the adverse psychological impact of traumatic events through a brief intervention immediately following the event. Specifically, Mitchell (1983) explains that CISD is usually applied in seven phases: introduction, facts, thoughts/impressions, emotional reactions, normalization, planning for the future, and disengagement (as cited in Wei, Szumilas, & Kutcher, 2010). Recent research, however, suggests that this practice may be less beneficial and more harmful than originally believed.

Many mental health professionals are experiencing growing concern over the use of PD. Rose, Bisson, & Wessely (2003) articulate this concern in their review of PD procedures, referring to PD as an example of a commonly-used intervention that lacks the evidence to support its use. The authors identify an absence of randomized control trials examining group PDs, but note that the few studies that have investigated this intervention provide little evidence supporting the notion that PD is useful as an early psychological intervention or may help protect against psychopathology following trauma. Devilly and Cotton (2004) report similar findings, stating that there are no reliable studies demonstrating the efficacy of CISD and arguing that it is an ineffective response to critical incident. Indeed, Adler and colleagues (2008) conducted an empirical study of the effectiveness of CISD in veterans and found that CISD failed to reduce post-trauma symptoms relative to individuals undergoing no treatment.

Several factors may contribute to the possible ineffectiveness of PD including CISD. It has been suggested that debriefing may occur too early post-trauma to accurately predict morbidity. Research has indicated that debriefing may be associated with adverse effects for certain individuals because it may lead to secondary traumatization through its use of imaginal exposure shortly after the traumatic event (Rose et al., 2003). Debriefing may also increase survivors’ expectations of developing psychological distress to the traumatic event when, if not for the debriefing, they may have only experienced normal distress levels. In other words, debriefing may increase individuals’ awareness of their distress, and in turn, increase overall distress (Rose et al., 2003). Furthermore, Devilly, Gist, and Cotton (2006) suggest that debriefing may lead individuals to circumvent social support from family or friends because of the belief that professional help will be more beneficial to recovery. This is problematic because research has shown that inadequate levels of social support are related to poorer psychological outcomes following multiple types of trauma, including natural disasters (Kaniasty & Norris, 1995; Ozer, Best, Lipsey, & Weiss, 2003; Polusny et al., 2011).

Despite growing evidence that PD may do more harm than good, some individuals maintain their belief that PD is important to implement following a traumatic event. For example, Walsh (2009) supports the use of PD—specifically for workers assisting with relief efforts following a traumatic event. According to Walsh, PD provides a way for individuals sharing a similar experience to connect and support one another throughout the recovery process.
Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is another common treatment for survivors of natural disasters. In CBT, the client and therapist meet approximately 8-12 times to engage in various exposure, behavioral, and cognitive exercises to address the client’s maladaptive trauma-related beliefs and reduce the client’s emotional disturbance following trauma (Foa et al., 2000). Maladaptive trauma-related beliefs are inaccurate thoughts that may develop following exposure to a natural disaster, including those involving assimilation (i.e., altering new information about the traumatic event into preexisting beliefs, such as “Bad things only happen to bad people – therefore, I must be a bad person because this bad event happened to me.”) or over accommodation (i.e., changing one’s beliefs about the self or world to increase feelings of safety or control, such as “I must always be on guard to keep bad things from happening again in the future.”). A common goal of CBT is accommodation, in which the client balances beliefs with the reality of the traumatic event (see Resick, Monson, & Chard, 2007 and Sobel, Resick, & Rabalais, 2009 for further details).

There are several variations of CBT including: exposure therapy, systematic desensitization, stress inoculation training, cognitive processing therapy, cognitive therapy, assertiveness training, biofeedback and relaxation training, and different combinations of the methods listed above. Research has demonstrated that CBT is one of the most beneficial treatments for trauma survivors, with the exposure component, or imaginal exposure to the event itself, thought to be a large factor in its success (Foa, Rothbaum, Riggs, & Murdock, 1991; Foa et al., 1999; Foa, et al., 2000). Furthermore, studies show that CBT typically has the best outcomes when it begins two to six weeks following the trauma and is completed in five to nine sessions (Devilly et al., 2006).

Preliminary research suggests that CBT may be appropriate for the treatment of PTSD and posttraumatic stress symptoms (Hamblen et al., 2009). Specifically, Hamblen et al. (2009) conducted a study investigating the effectiveness of Cognitive Behavior Therapy for Post-disaster Distress (CBT-PD) following Hurricane Katrina, a ten session CBT intervention provided at least 90 days post-disaster to address the client’s cognitive, behavioral, and emotional reactions to trauma. The use of CBT-PD was related to significant reductions in participants’ distress and worked equally well for individuals suffering from both moderate and severe stress levels. The percentage of participants experiencing severe distress decreased from 61% (pre-treatment) to 14% (post-treatment). This reduction in stress was maintained at 5 months post-treatment when researchers followed-up with participants.

Suggestions for Treatment

Although there has been a significant amount of research conducted looking at psychological outcomes and treatments for survivors of natural disasters—especially following Hurricane Katrina in 2005—there is still much work to be done. Specifically, the efficacy of various treatments, such as CBT, need to be tested with survivors of natural disasters. Likewise, new guidelines must be established and implemented so that responses to natural disasters are quicker and more people have access to the necessary psychological services.

Eliminating Psychological Debriefing/Critical Incident Stress Debreifing

Currently, PD/CISD is the treatment that seems to receive the most criticism—primarily due to the lack of empirical evidence supporting its use (i.e., Devilly and Cotton, 2004). Belaise, Fava, and Marks (2005) propose moving beyond PD/CISD and, instead, focusing more on the potential effectiveness of well-being therapy (WBT) in which individuals learn to focus on incidents of emotional well-being. Specifically, he says randomized control trials are needed to test this therapy because, during preliminary investigations, trauma survivors have responded particularly well to the exposure and cognitive restructuring components of WBT.

Similarly, Tuckey (2007) suggests investigating other interventions that are financially and logistically feasible for organizations to implement as an alternative to PD/CISD. Wei and colleagues (2010) also suggest eliminating PD/CISD because of the lack of evidence supporting its effectiveness and, instead, implementing five empirically supported intervention principles: promotion of a sense of safety, promotion of calm, promotion of a sense of self- and community efficacy, promotion of connectedness, and promotion of hope.

Implementing PFA, or psychological first aid, is another alternative to PD/CISD that has been proposed (Vernberg et al., 2008; Wei et al., 2010). The PFA Guide is available to psychologists needing to provide relief for disaster survivors (see Vernberg et al., 2008 for a more detailed description of PFA). PFA is guided by the approaches most consistently supported by empirical research so that they can be disseminated, employed, and further studied. There are eight core actions outlined in PFA: (1) contact and engagement, (2) safety and comfort, (3) stabilization, (4) information-gathering, (5) practical assistance, (6) connection with social supports, (7) information on coping, and (8) linkage with collaborative services. PFA also discusses several implications for practitioners including how to utilize current knowledge, suggestions for working with various groups, the evolution of training and available materials, self-care of healthcare providers, the need to recruit PFA providers, and the importance of evaluating current practices.

Focusing on the Efficacy of Cognitive-Behavioral Therapy in Natural Disaster Survivors

Although numerous studies have supported the effectiveness CBT in treating trauma survivors (i.e., Foa et al., 2000), much more research is needed. Specifically, research must be conducted evaluating CBT’s effectiveness in survivors of natural disasters; most existent research focuses on assault survivors and, generally, survivors of violence. What little research on implementing CBT with natural disaster survivors does exist focuses on adolescent populations (i.e., Shooshtary, Penaghi, & Moghdam, 2008). Further research is needed to test the effectiveness of CBT in adult survivors of natural disasters.

Implementation of Telehealth

Telehealth is an emerging method of delivering long-distance healthcare to clients unable to access local healthcare services. Telehealth is being applied in a variety of settings including primary care and specialty consultation. It is also being implemented to assist with medical logistics, coordinating transportation, and monitoring remote patients (Simmons et al., 2008). In a study looking at adults diagnosed with depression, the use of telehealth was shown to significantly reduce symptoms of depression at 6 months as well as improve mental functioning at both 6 weeks and 6 months (Hunkeler et al., 2000). Assuming the infrastructure is available, this may be a beneficial approach to employ in disaster situations because it can make reaching survivors and providing services easier (Simmons et al., 2008).

Telehealth could assist aid workers in being able to provide resources sooner to survivors of natural disaster. Schoenbaum and colleagues (2009) suggest using telehealth to reach individuals affected by natural disasters immediately after the disaster. Using telehealth would allow for the provision of long-distance mental health services to shelters via working telephone lines. Likewise, telehealth would be useful when individuals are unable to or encouraged not to leave their homes (Simmons et al., 2008). However, this leads to the need to consider variables such as accessibility, affordability, and applicability of this type of assistance following a natural disaster (Devilly et al., 2006).

Additional Recommendations

Be Discriminative

When treating individuals who have survived a natural disaster, mental health professionals need to distinguish between psychopathology and typical stress reactions (Ginzburg, 2008; Whaley, 2009). It is not uncommon for natural emotional distress to be mistaken for mental illness following a natural disaster. It is important that mental health professionals consider an individual’s overall functioning following the disaster to help guide decisions about diagnosing potential psychopathology (Whaley, 2009).

Likewise, mental health professionals must exercise caution not to “medicalise” distress symptoms. In other words, professionals should focus on not drawing unnecessary attention to symptoms that are typical of “normal” distress following a natural disaster. By drawing attention to symptoms unnecessarily, clients may become overly-focused on their symptoms and begin to experience more distress symptoms than they otherwise would have (Rose et al., 2003).
As Ginzburg (2008) points out, individuals who are diagnosed with a mental illness following a natural disaster may not have these diagnoses removed once symptoms begin to remit. As a result of maintaining their diagnoses, psychotherapy and/or medication may not be adjusted as necessary. This error can lead to the development of unnecessary distress once mental health relief workers begin to leave and mental health resources potentially become scarce. In order to avoid this unnecessary distress, it is important that mental health professionals are cognizant about re-assessing patients throughout the course of treatment to track the status of their disorder. Similarly, it is important that physicians treating survivors express the importance of frequently meeting with mental health professionals in order to receive the proper treatment following a natural disaster.

Rabins, Kass, Rutkow, Vernick, and Hodge (2011) recommend implementing advanced planning for responses to both natural and man-made disasters. Specifically, they recommend planning to first treat individuals who are particularly vulnerable to negative outcomes as a result of the disaster. For example, individuals who have preexisting mental health conditions and individuals reporting newly-emerging psychological symptoms should be treated before individuals not meeting those criteria. By implementing this advanced planning in the chaos following a disaster, mental health care providers would be able to systematically and efficiently triage care.

Implement Early Screening

The implementation of early screening, or looking for an illness that has not yet become apparent in a specific population, has been suggested by multiple mental health care professionals as a way to better-respond to the mental health care needs of natural disaster survivors. Others disagree with this recommendation, arguing that it will not be as effective as many individuals believe. For example, Brake and colleagues (2009) suggest that screening for adverse reactions, such as PTSD and acute stress, following a natural disorder is of no benefit. First, the authors state that early screening is futile because stress reactions within the first month after a natural disaster are “normal.” Furthermore, they allege that screening may lead to the “medicalization” of these normal stress symptoms. Additionally, Brake and colleagues (2009) state it is not cost-effective to screen natural disaster survivors, the literature has not yet identified an ideal time to conduct this screening, and screening is too inaccurate to be effective.

Contrary to the viewpoint Brake and researchers (2009) express, many mental health professionals view early screening following disasters as beneficial. For example, Ruggiero and colleagues (2009) recommend that disaster responders screen for depression as soon as survivors seek help for health-related concerns. Similarly, Koopman, Classen, and Speigel (1994) recommend using early screening measures that identify symptoms most predictive of future psychological disorders, such as dissociative experiences, immediately following the disaster. Preliminary research has supported the implementation of early screening procedures. In a study following survivors of an oil rig explosion in the North Sea, Holgersen, Klöckner, Boe, Weisaeth, and Holen (2011) concluded that an early screening intervention would have been able to identify survivors most at risk for developing long-term adverse effects.

In areas of trauma other than natural disaster, psychologists have begun creating measures to serve as quick, comprehensive ways to identify individuals who are most at risk for developing adverse reactions. For example, Winston, Kassam-Adams, Garcia-Espana, Ittenbach, and Cnaan (2003) developed the Screening Tool for Early Predictors of PTSD (STEEP). This instrument assesses individuals who have experienced a trauma, such as severe personal injury, within the past month. The STEEP is intended to help health professionals allocate resources, taking into account who has the greatest need for them. The measure was tested at a Level I trauma center, and was predictive of posttraumatic stress symptoms in approximately 90% of cases. Although this measure was not tested with a sample of natural disaster survivors, this is a type of early screening intervention that mental health professionals dealing with natural disaster survivors may want to consider creating and implementing in the future.

Get to Know Your Clients

The better a clinician can get to know his/her clients, the better he/she will be at providing the appropriate treatment for those clients (Ginzburg, 2008). Specifically, information on clients’ culture, including culturally-normative behavior, can be extremely valuable in determining a treatment path and making healthcare recommendations for clients. It is also important to be aware of the client’s personal needs and not make assumptions. For example, do not make assumptions that a client’s presenting problems will be directly related to the disaster he/she recently experienced. As advised by Whaley (2009), it may be beneficial to directly address any personal feelings of guilt or responsibility the client has relating to the event and help him/her reframe any events that were out of the client’s control. Once feelings of responsibility have been addressed, it may then be useful to get the client to focus on his/her own needs following the natural disaster.

Learning about a client’s family and friends can be beneficial in identifying a social support network following a natural disaster. Multiple studies have indicated that social support is an important factor for determining resilience following trauma (Galea et al., 2007; Lowe et al., 2010). Providing clients with information about where to connect with other survivors so they can communicate their feelings and responses to the disaster with individuals in similar situations can be important in helping them receive further support, learn self-help strategies, and develop contacts for further assistance (Devilly et al., 2006; Walsh, 2009).

To reiterate, it is crucial for the therapist to create a relationship with the client in which he/she feels comfortable revealing personal information that may prove useful during therapy. During Hurricane Katrina, some clinicians recommended that their clients stay with family to alleviate some of their stress (Whaley, 2009). However, this advice was often useless because many individuals’ families lived in close proximity to the disaster zone, and they, too, experienced a great deal of stress and loss. Had clinicians been more familiar with their clients, they could have provided more useful recommendations. However, instead of providing constructive recommendations, many clinicians only reminded their clients of the substantial loss they and their families were experiencing.

Consider the Health of Other Professionals—And Yourself!

Vicarious traumatization (VT), or the development of PTSD-like symptoms and changes in trauma-related cognitions in individuals not directly affected by a traumatic event, may develop among some professionals working with natural disaster survivors (as cited in Elwood, Mott, Lohr, & Galovski, 2011; Figley, 1995). VT can include general distress and a disruption of one’s beliefs and schemas (Farrell & Turpin, 2003). Symptomatic responses—especially intrusive thoughts related to the trauma—are more likely to develop than cognitive changes among mental health workers (Farrell & Turpin, 2003).

According to Figley (1995) VT is especially common in trauma-focused professionals, such as psychotherapists, but can affect anyone involved in helping an individual overcome a trauma including friends, family, and caregivers (as cited in Elwood et al., 2011). Research has indicated several predictors of VT including having a trauma history, experiencing life stress, suffering from mental illness, having a lack of social support, having achieved low educational attainment, being young, and implementing negative coping strategies, such as substance use (Lerias & Byrne, 2003). Argento and Ilaria (2011) found that role clarity and job support at one’s workplace were also inversely related to the development of VT in rescue workers.

Ginzburg (2008) noted the importance of paying attention to how fellow mental health professionals who are working with natural disaster survivors are faring. It is imperative to remember that professionals are also being exposed to and impacted by the devastating effects of natural disaster they are witnessing. Similarly, individuals in other service positions, such as police officers and firefighters, may display aversive reactions to the traumatic event (Ginzburg, 2008; Marmar, Weiss, Metzler, & Delucchi, 1996; Walsh, 2009).

According to data collected by Ginzburg (2008), several months after Hurricane Katrina, nearly 27% of firefighters contacted by the researcher’s team reported symptoms of depression, and 22% reported posttraumatic stress symptoms. Likewise, 26% of police officers reported depression symptoms and nearly 19% displayed posttraumatic stress symptoms. In a similar study following an earthquake in China, nearly 7% of military first responders met the diagnostic criteria for PTSD six months after the disaster (Wang et al., 2011). Walsh (2009) recommends that all organizations—both government and volunteer—provide trauma training for their workers who may someday respond to a disaster situation. For example, in a study by Fullerton, McCarroll, Ursano, and Wright (1992), firefighters reported significantly less stress responding to an emergency situation when they felt they had received the proper training prior to the event.
A lot about VT is still unknown, and further research must be conducted investigating predictors, symptoms, and prevention related to VT (Farrell & Turpin, 2003). Ellwood and colleagues (2011) recommend that employers work to provide more treatment options for trauma workers. They also recommended that trauma workers receive more training about how to respond to traumatic events, and they should also be more educated about VT.

Concluding Comments

Each year, natural disasters cause individuals significant emotional distress in the form of posttraumatic stress symptoms, depression, anxiety, substance use, and other adverse effects. Survivors of natural disasters who are women, suffer from preexisting mental health issues, interpret the disaster in a negative way, suffer extreme exposure to the disaster, and have low social support are the most likely to develop negative psychological outcomes following the event. Female Caucasian individuals who are middle-aged, have high or extremely low educational attainment, have access to transportation and technology, and do not hold negative attitudes towards mental healthcare are the most likely to receive treatment after a natural disaster.

Currently, there are two primary methods used to treat survivors of natural disaster who are suffering adverse effects: CISD/PD and CBT. Research exploring both therapies has consistently indicated that CBT is the superior treatment method, and several studies have even suggested that CISD/PD be abolished altogether. Furthermore, many mental health professionals believe that the current treatment methods, alone, are not sufficient. Researchers suggest that other treatments, such as WBT, PFA, and telehealth be explored further. Additionally, it is important for trauma workers to keep in close contact with their clients as well as pay attention for signs of VT in both themselves and other professionals. Much work is still needed in the area of psychological treatment for natural disaster survivors. Considering the large number of natural disasters occurring around the world in recent years, it is imperative that this area of psychology be given more attention than it has in the past. Consequently, new interventions must be implemented so that natural disaster survivors experience the fewest long-term negative psychological outcomes possible.

References

Adler, A. B., Litz, B. T., Castro, C. A., Suvak, M., Thomas, J. L., Burrell, L.,…Bliese, P. D. (2008). A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers. Journal of Traumatic Stress, 21, 253-263. doi:10.1002/jts.20342

American Psychiatric Association [APA]. (2000). Diagnositc and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.

Argentero, P., & Ilaria, S. (2011). Engagement and vicarious traumatization in rescue workers. International Archives of Occupational and Environmental Health, 84, 67-75. doi: 10.1007/s00420-010-0601-8

Başoğlu, M., Kiliç, C., Şalcioğlu, E., & Livanou, M. (2004). Prevalence of posttraumatic stress disorder and comorbid depression in earthquake survivors in Turkey: An epidemiological study. Journal of Traumatic Stress, 17, 133-141. doi: 10.1023/B:JOTS.0000022619.31615.e8

Beaudoin, C. E. (2011). Hurricane Katrina: Addictive behavior trends and predictors. Public Health, 126, 400-409. Retrieved from www.publichealthreports.org/

Belaise, C., Fava, G. A., & Marks, I. M. (2005). Alternatives to debriefing and modifications to cognitive behavior therapy for posttraumatic stress disorder. Psychotherapy and Psychosomatics, 74, 212-217. doi: 10.1159/0000885144

Bland, S. H., O’Leary, E. S., Farinaro, E., Jossa, F., & Trevisan, M. (1996). Long-term psychological effects of natural disasters. Psychosomatic Medicine, 58, 18-24. Retrieved from: http://www.psychosomaticmedicine.org

Boe, H. J., Holgersen, K. H., & Holen, A. (2010). Reactivation of posttraumatic stress in male disaster survivors: The role of residual symptoms. Journal of Anxiety Disorder, 24, 397-402. doi: 10.1016/j.janxdis.2010.02.003

Brake, H. T., Duckers, M., De Vries, M., Van Duin,D., Rooze, M., & Spreeuwenberg, C. (2009). Early psychosocial interventions after disasters, terrorism, and other shocking events: Guideline development. Nursing & Health Sciences, 11, 336-343. doi: 10.111/j.1442-2018.2009.00491.x

Breslau, N., Davis, G. C., & Schultz, L. R. (2003). Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry, 60, 289-294. doi: 10.1001/archpsyc.60.3.289

Carr, V. J., Lewin, T. J., Webster, R. A., Kenardy, J. A., Hazell, P. L., & Carter, G. L. (1997). Psychosocial sequelae of the 1989 Newcastle earthquake .2. Esposure and morbidity profiles during the first 2 years post-disaster. Psychological Medicine, 27, 167-178. doi: 10.1017/S0033291796004278

Chen, C. C., Yeh, T. L., Yang, Y. K., Chen, S. J., Lee, I. H., Fu, L. S.,…Si, Y. C. (2001). Psychiatric morbidity and post-traumatic symptoms among survivors in the early stage following the 1999 earthquake in Taiwan. Psychiatry Research, 105, 13-22. doi: 10.1016/S0165-1781(01)00334-1

David, D., Mellman, T. A., Mendoza, L. M., Kulick-Bell, R., Ironson, G., & Schneiderman, N. (1996). Psychiatric morbidity following Hurricane Andrew. Journal of Traumatic Stress, 9, 607-612. doi: 10.1002/jts.2490090316

Davis, T. E. III, Grills-Taquechel, A. E., & Ollendick, T. H. (2010). The psychological impact from Hurricane Katrina: Effects of displacement and trauma exposure on university students. Behavior Therapy, 41, 340-349. doi: 10.1016/j.beth.2009.09.004

Devilly, G. J., & Cotton, P. (2004). Caveat emptom, caveat venditor, and critical incident stress debriefing/management (CISD/M). Australian Psychologist, 39, 35-40. doi: 10.1080/00050060410001660317

Devilly, G. J., Gist, R., & Cotton, P. (2006). Ready! Fire! Aim! The status of psychological debriefing and therapeutic interventions: In the work place and after disasters. Review of General Psychology, 10, 318-345. doi: 10.1037/1089-2680.10.4.318

Elwood, L. S., Mott, J., Lohr, J. M., & Galovski, T. E. (2011). Secondary trauma symptoms in clinicians: A critical review of the construct, specificity, and implications for trauma-focused treatment. Clinical Psychology Review, 31, 25-36. doi: 10.1016/j.cpr.2010.09.004

Farrell, R. S., & Turpin, G. (2003). Vicarious traumatization: implications for the mental health of workers? Clinical Psychology Review, 23, 449-480. doi: 0.1016/S0272-7358(03)00030-8

Fetzner, M. G., McMillian, K. A., Sareen, J., & Asmundson, G. J. (2011). What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample. Depression and Anxiety, 28, 632-638. Doi: 10.1002/da.20852

Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194-200. doi: 10.1037/0022-006X.67.2.194

Foa, E. B., Keane, T. M., & Friedman, M. J. (2000). Guidelines for treatment of PTSD—Introduction (reprinted from Effective Treatments for PTSD, 2000). Journal of Traumatic Stress, 31, 539-588. doi: 10.1023/A:1007802031411

Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic stress disorder in rape victims: Comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723. doi: 10.1037/0022-006X.59.5.715

Fullerton, C. S., McCarroll, J. E., Ursano, R. J., & Wright, K. M. (1992). Psychological responses of rescue workers—fire fighters and trauma. American Journal of Orthopsychiatry, 62, 371-378. doi: 10.1037/h0079363

Galea, S., Brewin, C. R., Bruber, M., Jones, R. T., King, D. W., King, L. A., …Kessler, R. C. (2007). Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Archives of General Psychiatry, 64, 1427-1434. doi: 10.1001/archpsyc.64.12.1427

Galea, S., Nandi, A., & Vlahov, D. (2005). The epidemiology of Post-Traumatic Stress Disorder after disasters. Epidemiologic Reviews, 27, 78-91. doi: 10.1093/epirev/mxi003

Ginzburg, H. M. (2008). Long-term psychiatric consequences of Hurricane Katrina. Psychiatric Annals, 38, 81-91. doi: 10.3928/00485713-20080201-04

Hamblen, J. L., Norris, F. H., Pietruszkiewicz, S., Gibson, L. E., Naturale, A., & Louis, C. (2009). Cognitive behavioral therapy for postdisaster distress: A community based treatment program for survivors of Hurricane Katrina. Administration and Policy in Mental Health and Mental Health Services Research, 36, 206-214. doi: 10.1007/s10488-009-0213-3

Holgersen, K. H., Klöckner, C. A., Boe, H. J., Weisaeth, L., & Holen, A. (2011). Disaster survivors in their third decade: Trajectories of initial stress responses and long-term course of mental health. Journal of Traumatic Stress, 24, 334-341. doi: doi:10.1002/jts.20636

Hunkeler, E. M., Meresman, J. F., Hargreaves, W. A., Fireman, B., Berman, W. H., Kirsch, A. J…Salzer, M. (2000). Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Archives of Family Medicine, 9, 700-708. doi: 10.1001/archfami.9.8.700

Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158, 1184-1190. doi: 10.1176/appi.ajp/158.8.1184

Kaniasty, K., & Norris, F. H. (1995). Mobilization and deterioration of social support following natural disasters. Current Directions in Psychological Science, 4(3), 94-98. doi: 10.111/1467-8721.ep10772341

Karanci, A. N., & Rustemli, A. (1995). Psychological consequences of the 1992 Erzincan (Turkey) earthquake. Disasters, 19, 8-18. doi: 10.1111/.1467-7717.1995.tb00328.x

Kessler, R. C., Galea, S., Jones, R. T., & Parker, H. A. (2006). Mental illness and suicidality after Huricane Katrina. Bulletin of the World Health Organization, 84, 930-939. doi: 10.2471/BLT.06.033019

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic-stress-disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048-1060. Retrieved from http://archpsyc.ama-assn.org/

Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance use, childhood traumatic experience, and posttraumatic stress disorder in an urban civilian population. Depression and Anxiety, 27, 1077-1086. doi: 10.1002/da.2071

Koopman, C., Classen, C., & Spiegel, D. (1994). Predictors of posttraumatic stress symptoms among survivors of the Oakland/Berkeley, Calif., firestorm. American Journal of Psychiatry, 151, 888-894. Retrieved from http://ajp.psychiatryonline.org/

Krug, E. G., Kresnow, M. J., Peddicord, J. P., Dahlberg, L. L., Powell, K. E., Crosby, A. E., & Annest, J. L. (1999). Retraction: Suicide after natural disasters. New England Journal of Medicine, 340, 148-149. doi: 10.1056/NEJM199901143400213

Kuo, C. J., Tang, H. S., Tsay, C. J., Lin, S. K., Hu, W. H., & Chen, C. C. (2003). Prevalence of psychiatric disorders among bereaved survivors of a disastrous earthquake in Taiwan. Psychiatric Services, 54, 249-251. doi: 10.1176/appi.ps.54.2.249

Kwon, Y. S., Maruyama, S., & Morimoto, K. (2001). Life events and posttraumatic stress in Hanshin-Awaji earthquake victims. Environmental Health and Preventive Medicine, 6, 97-103. doi: 10.1007/BF02897953

Lerias, D., & Byrne, M. K. (2003). Vicatious traumatization: symptoms and predictors. Stress and Health, 19, 129-138. doi: 10.1002/smi.969

Lowe, S. R., Chan, C. S., & Rhodes, J. E. (2010). Pre-hurricane perceived social support protects against psychological distress: A longitudinal analysis of low-income mothers. Journal of Consulting and Clinical Psychology, 78, 551-560. doi: 10.1037/a0018317

Marmar, C. R., Weiss, D. S., Metzler, T. J., & Delucchi, K. (1996). Characteristics of emergency services personnel related to peritraumatic dissociation during critical incident exposure. American Journal of Psychiatry, 153, 94-102. Retrieved from ajp.psychiatryonline.org/

Mason, V., Andrews, H., & Upton, D. (2010). The psychological impact of exposure to floods. Psychology Health & Medicine, 15, 61-73. doi: 10.1080/13548500903483478

McFarlane, A. C. (1988). The etiology of post-traumatic stress disorders following a natural disaster. British Journal of Psychiatry, 152, 116-121. doi: 10.1192/bjp.152.1.116

McFarlane, A. C., & Papay, P. (1992). Multiple diagnoses in posttraumatic-stress-disorder in the victims of a natural disaster. Journal of Nervous and Mental Disease, 8, 498-504. doi: 10.1097/00005053-199208000-00004

McLeish, A. C., & Del Ben, K. S. (2008). Symptoms of depression and posttraumatic stress disorder in an outpatient population before and after Hurricane Katrina. Depression and Anxiety, 25, 406-421. doi: 10.1002/da.20426

McMillen, C., North, C., Mosley, M., & Smith, E. (2002). Untangling the psychiatric comorbidity of posttraumatic stress disorder in a sample of flood survivors. Comprehensive Psychiatry, 43, 478-485. doi: 10.1053/comp.2002.34632

Mezuk, B., Larkin, G. L., Prescott, M. R., Tracy, M., Vlahov, D., Tardiff, K., & Galea, S. (2009). The influence of a major disaster on suicide risk on the population. Journal of Traumatic Stress, 22, 481-488. doi: 10.1002/jts.20473

Nolen-Hoeksema, A., & Morrow, J. (1991). A prospective-study of depression and posttraumatic stress symptoms after a natural disaster-the 1989 Loma-Prieta earthquake. Journal of Personality and Social Psychology, 61, 115-121. doi: 10.1037/0022-3514.61.1.115

North, C. S., Kawasaki, A., Spitznagel, E. L., & Hong, B. A. (2004). The course of PTSD, major depression, substance abuse, and somatization after a natural disaster. Journal of Nervous and Mental Disease, 192, 823-829. doi: 10.1097/01.nmd.0000146911.52616.22

Nutting, P. A., Rost, K., Smith, J., Werner, J. J., & Eliot, C. (2000). Competing demands from physical problems: Effect on initiating and completing depression care over 6 months. Archives of Family Medicine, 9, 1059-1064. doi: 10.1001/archfami.9.10.1059

Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52-73. doi: 10.1037/0033-2909.129.1.52

Parslow, R. A., & Jorm, A. F. (2006). Tobacco use after experiencing a major natural disaster: Analysis of a longitudinal study of 2063 young adults. Addiction, 101, 1044-1050. doi: 10.1111/j.1360-0443.2006.01481.x

Polusny, M. A., Erbes, C. R., Murdoch, M., Arbisi, P. A., Thuras, P., & Rath, M. B. (2011). Prospective risk factors for new-onset post-traumatic stress disorder in National Guard soldiers deployed to Iraq. Psychological Medicine, 41, 687-698. doi: 10.1017/S0033291710002047

Polusny, M. A., Ries, B. J., Schultz, J. R., Calhoun, P., Clemensen, L., & Johnsen, I. R. (2008). PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster. Journal of Traumatic Stress, 21, 75-83. doi: 10.1002/jts.20281

Rabins, P. V., Kass, N. E., Rutkow, L., Vernick, J. S., & Hodge, J. G. (2011). Challenges for mental health services raised by disaster preparedness: Mapping the ethical and therapeutic terrain. Biosecurity and Bioterriorism-Biodefense Strategy Practice and Science, 9(2), 175-179. doi: 10.1089/bsp.2010.0068

Resick, P. A., Monson, C. M., & Chard, K. M. (2007). Cognitive processing therapy: Veteran/military version. Washington, DC: Department of Veterans’ Affairs.

Rhodes, J., Chan, C., Paxson, C., Rouse, C. E., Waters, M., & Russell, E. (2010). The impact of Hurricane Katrina on the mental and physical health of low-income parents in New Orleans. American Journal of Orthopsychiatry, 80, 237-247. doi: 10.1111/j.1939-0025.2010.01027.x

Rose, S., Bisson, J., & Wessely, S. (2003). A systematic review of single-session psychological interventions (‘debriefing’) following trauma. Psychotherapy and Psychosomatics, 72, 176-184. doi: 10.1159/000070781

Rosen, C. S., Matthieu, M. M., & Norris, F. H. (2009). Factors predicting crisis counselor referrals to other crisis counseling, disaster relief, and psychological services: a cross-site analysis of post-Katrina programs. Adm Policy Ment Health, 36, 186-194. doi: 10.1007/s10488-009-0216-0

Roy-Byrne, P. P., Joesch, J. M., Wang, P. S., Kessler, R. C. (2009). Low socioeconomic status and mental health care use among respondents with anxiety and depression in the NCS-R. Psychiatric Services, 60, 1190-1197. doi: 10.1176/appi.ps.60.9.1190

Ruggiero, K. J., Amstadter, A. B., Acierno, R., Kilpatrick, D. G., Resnick, H. S., Tracy, M., & Galea, S. (2009). Social and psychological resources associated with health status in a representative sample of adults affected by the 2004 Florida hurricanes. Psychiatry-Interpresonal and Biological Processes, 72, 195-210. doi: 10.1521/psyc.2009.72.2.195

Schoenbaum, M., Butler, B., Kataoka, S., Norquist, G., Springgate, B., Sullivan, G.,…Wells, K. (2009). Promoting mental health recovery after Hurricanes Katrina and Rita: What can be done at what cost. Archives of General Psychiatry, 66, 906-914. doi: doi:10.1001/archgenpsychiatry.2009.77

Shooshtary, M. H., Panaghi, L., & Moghadam, J. A. (2008). Outcome of cognitive behavioral therapy in adolescents after natural disaster. Journal of Adolescent Health, 42, 466-472. doi: 10.1016/j.jadohealth.2007.09.011

Simmons, S., Alverson, D., Poropatich, R., D’lorio, J., DeVany, M., & Doarn, C. R. (2008). Applying telehealth in natural and anthropogenic disasters. Telemedicine and e-Health, 14, 968-971. doi: 10.1089/tmj.2008.0117

Sobel, A.A., Resick, P.A., & Rabalais, A.E. (2009). The effect of cognitive processing therapy on cognitions: Impact statement coding. Journal of Traumatic Stress, 22(3), 205-211. doi: 10.1002/jts.20408

Thompson, M. P., Norris, F. H., & Hanacek, B. (1993). Age-differences in the psychological consequences of Hurricane Hugo. Psychology and Aging, 8, 606-616. doi: 10.1037/0882-7974.8.4.606

Tobin, G. A., & Ollenburger, J. C. (1996). Predicting levels of postdisaster stress in adults following the 1993 floods in the upper Midwest. Environment and Behavior, 28, 340-357. doi: 10.1177/0013916596283004

Tuckey, M. R. (2007). Issues in the debriefing debate for the emergency services: Moving research outcomes forward. Clinical Psychology-Science and Practice, 14, 102-116. doi: 10.1111/j.1468-2850.2007.00069.x

van Griensven, F., Chakkraband, M. L., Thienkrua, W., Pengjuntr, W., Cardozo, B. L., Tantipiwatanaskul, P.,…Tappero, J. W. (2006). Mental health problems among adults in tsunami-affected areas in sourthern Thailand. JAMA-Journal of the American Medical Association, 296, 537-548. doi: 10.1001/jama.296.5.537

Vernberg, E. M., Steinberg, A. M., Jacobs, A. K., Brymer, M. J., Watson, P. J., Osofsky, J. D.,…Ruzek, J. I. (2008). Innovations in disaster mental health: psychological first aid. Professional Psychology: Research and Practice, 39, 381-388. doi: 10.1037/a0012663

Walsh, D. S. (2009). Interventions to reduce psychosocial disturbance following humanitarian relief efforts involving natural disasters: An integrative review. International Journal of Nursing Practice, 15, 231-240. doi: 10.1111/j/1440-172X.2009.01766.x

Wang, H. L., Jim, H., Nunnink, S. E., Guo, W., Sun, J., Shi, J. A…Baker, D. G. (2011). Identification of post traumatic stress disorder and risk factors in military first responders 6 months after Wen Chuan earthquake in China. Journal of Affective Disorders, 130, 213-219. doi: 10.1016/j.jad.2010.09.026

Wang, P. S., Gruber, M. J., Powers, R. E., Schoenbaum, M., Speier, A. H., Wells, K. B., & Kessler, R. C. (2007). Mental health service use among Hurricane Katrina survivors in the eight months after the disaster. Psychiatric Services, 58, 1403-1411. doi: 10.1176/appi.ps.58.11.1403

Wang, P. S., Gruber, M. J., Powers, R. E., Schoenbaum, M., Speier, A. H., Wells, K. B., & Kessler, R. C. (2008). Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. American Journal of Psychiatry, 165, 34-41. doi: 10.1176/appi.ajp.2007.07030502

Weems, C. F., Watts, S. E., Marsee, M. A., Taylor, L. K., Costa, N. M., Cannon, M. F.,…Pina, A. A. (2007). The psychosocial impact of Hurricane Katrina: Contextual differences in psychological symptoms, social support, and discrimination. Behaviour Research and Therapy, 45, 2295-2306. doi: 10.1016/j.brat.2007.04.013

Wei, Y., Szumilas, M., & Kutcher, S. (2010). Effectiveness on mental health of psychological debriefing for crisis intervention in schools. Educational Psychology Review, 22, 339-347. doi: 10.1007/s10648-010-9139-2

Whaley, A. L. (2009). Trauma among survivors of Hurricane Katrina: Considerations and Recommendations for mental health care. Journal of Loss & Trauma, 14, 459-476. doi:10.1080/15325020902925480

Winston, F. K., Kassam-Adams, N., Garcia-Espana, F., Ittenbach, R., & Cnaan, A. (2003). Screening for risk of persistent posttraumatic stress in injured children and their parents. JAMA-Journal of the American Medical Association, 290, 643-649. doi: 10.1001/jama.290.5.643

Authors’ Biographies

Lauren T. Bradel, MA

BradelLauren is a fourth year clinical doctoral student at Northern Illinois University.  Lauren received her Bachelor’s degree from the University of St. Thomas in St. Paul, Minnesota and her Master’s degree from Northern Illinois University.  As an undergraduate, Lauren worked with Dr. Melissa Polusny at the Minneapolis Veterans Affairs Medical Center where she assisted with research focused on soldiers returning from Iraq and Afghanistan.  At Northern Illinois University, Lauren has worked with Drs. Holly Orcutt, Kathryn Bell, and Alan Rosenbaum.  Her primary research interests include identification of risk factors for intimate partner violence perpetration and the identification of risk factors for developing psychopathology following trauma.

 

Kathryn M. Bell, PhD

BellDr. Bell is an assistant professor within the Psychology Department at Capital University. She received her doctorate in clinical psychology at Western Michigan University and completed her clinical internship in the Behavioral Sciences Division of the National Center for PTSD within the Boston VA Medical Center. Dr. Bell completed a two-year clinical research postdoctoral fellowship through The Warren Alpert Medical School of Brown University and served as an assistant professor for three years within the clinical psychology program at Northern Illinois University. She has published extensively in the areas of trauma and interpersonal violence.


Chemophobia & Other Food Nonsense

Chemophobia & Other Food Nonsense

Published May 5th, 2015 in Alternative Perspective, Eat for Health, What’s in the News

by Tammera J. Karr, PhD

I’m about to make a confession – There are times I have no clue as to what to write this column on. This week was just one of those times. The clock was ticking, and the deadline was at hand, and still I had no inkling, shimmer or clue. Then I picked up the mail and began looking through a Food Product Journal for “Innovation, Ingredients, Science, and Compliance.” One of our long time friends told me years ago that it was important to know both sides of the story, that way your enemies never catch you unawares.

This holds true for the world of food also.

As I thumbed through the pages, I saw the word “Chemophobia”, this halted me and required a closer examination – to which head shaking and laughter ensued. “Chemicals are Chemicals, whether found in nature or made by man. But, consumer advocates are sounding the alarm concerning the perceived dangers of artificial flavors.” “Nothing is more indicative of this chemophobia in today’s foodscape than the growing preference for natural versus artificial flavors.” The article goes on to detail how unstable natural flavors are compared to synthetic, that stabilize and preserve while saving cost for the manufacture;” the author stated.

Hummmmm.

So I thought I’d look at the listed synthetic food flavors in the article….

Terpenes: “The name “terpene” is derived from the word “turpentine”. A range of terpenes have been identified as high-value chemicals in food, cosmetic, pharmaceutical and biotechnology industries. Chemical synthesis of terpenes can be problematic because of their complex structure, and plants produce very small amounts of these valuable chemicals, making it difficult, time-consuming, and expensive to extract them directly from plants. Research into terpenes has found that many of them make ideal natural agricultural pesticides. Terpin hydrate, an expectorant and humectant, is used in the treatment of acute or chronic bronchitis and related conditions. Terpenes are used by termites to attack enemy insects.
Ok that doesn’t sound horrible – well until you get to the termites that is. So in essence we are using fake tree sap made from yeast to make food, medicines, perfumes and pesticides.

Glutamic acid: glutamic acid is known as glutamates. In neuroscience, glutamate is an important neurotransmitter that plays the principal role in neural activation. In 1908 Japanese researcher Kikunae Ikeda of the Tokyo Imperial University identified brown crystals left behind after the evaporation of a large amount of kombu broth as glutamic acid. Professor Ikeda termed this flavor umami. He then patented a method of mass-producing a crystalline salt of glutamic acid, monosodium glutamate.

Warning: people with kidney or liver disease or those with neurological diseases, including ALS or Lou Gehrig’s disease, and epilepsy, should not take glutamic acid without consulting a physician. According to a 2010 article in “Neuron Glia Biology,” people who cannot metabolize glutamic acid properly can develop problems associated with a number of neurological conditions, including epilepsy. MSG can cause symptoms ranging from headache and flushing of the skin to chest pain. The effects are potentially dangerous palpitations, shortness of breath, and swelling of the throat, a sign of anaphylaxis, says MedlinePlus.

So of the two chemical compounds listed, one may not be so bad, and the other may be life threatening for some. Sounds a little like Russian Roulette to me.

While this and several other articles suggested we, the consumers, are a bit daft in the head, and are easily lead astray by “food advocates” The rest of the journal was dedicated to Consumer Market trends and how to score big with “Clean Labels”. Here is some of the shared information I found interesting.

a.) 53% of consumers who bought a gluten free food or beverage did not know it was GF.
b.) Since 2013, there have been over 2400 new food and drink launches sporting a “no additives or preservatives” claim.
c.) Almond milk has surpassed soy milk and accounts for 55% of the alternative beverage market.
d.) More than 70% of adults purchased foods or beverages with clean-label package claims in 2012.
e.) The gluten free market reached over 23 billion in 2014
f.) Due to the lack of clarity around the definition of “natural” consumers are targeting foods with clean and simple labels.

So it would seem, while I might be a mad-hatter for wanting clean food, the industry is delighted over the money I’m willing to spend for it. And don’t think for a moment they are not working to get an even bigger market share of local foods and produce, after all the largest funder for this journal is ConAgra.

To Your Good Health and Information

Sources

http://www.theweedblog.com/terpenes-and-the-smell-of-marijuana/_truncated

Thimmappa, R.; Geisler, K.; Louveau, T.; O’Maille, P.; Osbourn, A. (2014). “Triterpene biosynthesis in plants”. Annu Rev Plant Biol. 65: 225–57. doi:10.1146/annurev-arplant-050312-120229. Retrieved 19 January 2015.
Augustin, J.M.; Kuzina, V.; Andersen, S.B.; Bak, S. (2011). “Molecular activities, biosynthesis and evolution of triterpenoid saponins”. Phytochemistry 72: 435–57. doi:10.1016/j.phytochem.2011.01.015. Retrieved 19 January 2015.

http://en.wikipedia.org/wiki/Terpene_truncated

http://en.wikipedia.org/wiki/Terpene

Renton, Alex (2005-07-10). “If MSG is so bad for you, why doesn’t everyone in Asia have a headache?”. The Guardian. Retrieved 2008-11-21.
“Kikunae Ikeda Sodium Glutamate”. Japan Patent Office. 2002-10-07. Retrieved 2008-11-21.

http://www.livestrong.com/article/271301-side-effects-of-glutamic-acid/_truncated

http://www.livestrong.com/article/271301-side-effects-of-glutamic-acid/


Lucy Postolov, Licensed Acupuncturist and Herbalist

About Lucy Postolov, LAc, Licensed Acupuncturist and Herbalist    



Postolov-LucyThe American dream is often defined by a ‘rags to riches’ story. In Lucy Postolov’s situation, she left behind Russian culture, intelligent and educated family members and career achievement to pursue spiritual and political freedom. Lucy Postolov was born in 1960 in Tashkent, capital of Uzbekistan, at that time one of the republics of Soviet Russia. By the time she was 23 she had earned her medical degree from Tashkent Medical School and later completed her residency in neurology. Always interested in Oriental Medicine, Lucy received her post medical specialty in Acupuncture and Acupressure. Being a strong willed woman, Lucy yearned for more out of life for herself and her family. In 1989, the government allowed Lucy, her husband Tony, and their 4-year-old daughter Annie to leave the country with two suitcases each – minus any valuables – and $90 per person. With only one distant relative in the United States, they arrived in California with a hopeful eye on an uncertain future.

Lucy was 29 years old when she arrived in America and she had to begin all over again. Her medical qualifications and those of her surgeon husband were not recognized in the U.S. While Tony retrained as a psychiatrist, Lucy supported her family by working as a lab technician at the California Cryobank. Working full-time, Lucy was also attending Emperors College of Oriental Medicine to obtain her master’s degree in Oriental Medicine. Her average week would be eighty hours but she felt fulfilled since she was doing something meaningful.

After completing her master’s degree in three years, she started an Oriental Medicine practice at a West Los Angeles Clinic, treating patients while continuing to work as a consultant at the Cryobank where she spearheaded the Stem Cell Program, years ahead of its time. Her success in her private practice allowed her to open her own Acupuncture/Herbology treatment center, The Postolova Acupuncture Group located in Brentwood. In 1999, Lucy continued her commitment to a holistic approach to healing by taking a position as consultant/acupuncturist with the ground-breaking Department of Integrative Medicine at the prestigious Cedars-Sinai Medical Center. In 2000 she was the first licensed acupuncturist to be granted full privileges at the world-renowned Cedars-Sinai Medical Center.

In 2010, Lucy received Board Certification in Integrative Medicine by the American Association of Integrative Medicine.

Lucy’s passion for helping others has her working with a wide variety of health issues including cancer, infertility, weight loss, menopause, neurological disorders, addiction etc. She has been certified by NADA (National Acupuncture Detoxification Program) and works successfully with many different types of addiction.  In 2001, she released a meditation CD for patients with cancer pain. Her work with oncology patients was recognized by the Israel Cancer Research Fund and she was honored with the “Woman of Action” award in 1998. She has also appeared on numerous news programs as an expert in Traditional Oriental Medicine and has been featured on the KCET program Healthweek and ABC’s Good Day L.A. In 2008, Lucy contributed a chapter to the book “Guidebook of Sexual Medicine”.

Hundreds of Lucy’s patients were able to make their biggest dream come true, have a child. Lucy works with infertility patients, when Western OBGYN gave up and she’s also working with many famous fertility doctors, hand in hand.

Lucy is an expert when it comes to female disorders. Polycystic ovaries, Endometriosis, fibroids and many hormonal disorders.

Lucy’s special desire to empower women with a sense of their own well being compelled her to help them revitalize their appearance using natural methods. She appreciated the importance for women of all ages to feel good about themselves and the way they look. She’s one of the first healthcare practitioners who started using Arasys, a revolutionary system for face rejuvenation and body inch /weight loss . Designed by the inventor of the pacemaker, this system is very popular in Europe and a well kept secret in the United States. Many of Lucy’s patients have been using the Arasys system with extraordinary results. It is Lucy’s hope to be able to bring this product to all women.

Lucy lectures both internationally and nationwide. She has been invited to speak in Paris and here in the USA at UCLA, Tulane School of Medicine, Cedars-Sinai Medical Center, Tower Oncology Cancer Research Foundation, Cancer Support Community / Benjamin Center and many others.

She is on the Physician Advisory Board for the Cancer Support Community. In 2012, Lucy was invited as an Independent Consultant for Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute. In 2015, she was recognized by the Los Angeles Business Journal as a ‘Woman Making a Difference’.

Lucy’s work is a testimony to not only the vital treatments she offers, (support of cancer patients, infertility, inch and weight loss, facial rejuvenation (Arasys) and many others.) but to her ability to understand the best of what Chinese and Western medicine has to offer. She works hard and she knows what it means to live fully and how to make a difference.


Dr. Juan Paolo Bellosillo

Dr. Juan Paolo Bellosillo ND, MCL, DWMS, DAAIM, MAURP

C.Homotoxicology

BellosilloDr. Juan Paolo Bellosillo, was named after and blessed by the late Saint John Paul II in the Philippines Nunciature and has embarked on Preventive Medicine Campaign through Medicine and Media, showing compassion and nobility in service with every beat of his heart.

He had finished his schooling from the Ateneo De Manila University Loyola Schools in Economics, which included additional concentrations in Natural Sciences, Math, Law and Foreign Languages. Subsequently, he pursued his Masters at the School of Urban and Regional Planning as University Scholar in the University of the Philippines while juggling work in wellness and healthcare. He has undergone and survived two near death experiences, that took him to the Emergency Room brought about by progressed arteriosclerosis and atherosclerosis of the heart. Consequently, he pursued his Natural Medicine and Energy Medicine at the IFP Institute Official School of Naturopathy and Natural Sciences and graduated Magna Cum Laude.

The desire to prevent the growth of mortalities due to heart attacks from house to community, to city, to region, and eventually, nationwide gave him the perseverance and determination to study in Germany’s International Academy for Homotoxicology to augment his arsenal against acute, chronic and degenerative diseases. He also pursued his continuing naturopathic doctor education in the areas of preventive cardiology, nutrition, anti-aging medicine, sports medicine through the University of Bridgeport, US. Moreover, he furthered his knowledge in Metabolic Cardio treatment through the Institute for Integrative Medicine supplemented by the teachings of his Uncle, Dr. Adolfo Bellosillo the former president of the Philippine Heart Association. Having gone through training and education in sports and nutrition, he supports athletes and the general public; fueling their performance in competitive races or the race of life. He too was educated and trained under the Philippine Red Cross in the areas of life support and first aid. He was President of his class composed of 70 nurses and allopathic doctors. Combined with Tactical Medicine through a Multi Jurisdictional Task Force program (US), he led a team of Coast Guard Auxiliary and First Responders in a Medical Psychological Mission in the heart of Tacloban Leyte, during Typhoon Yolanda-Haiyan.

Dr. Pao, as he is fondly called in television, has gone from resource speaker to hosting stints in some TV programs such as Doctor’s on TV, Rise and Shine, Good Morning Kuya as well as an Eco Travel Show in Studio 23, ABS-CBN. He uses television to educate, reach out to people and inform them of the ways and means to avoid diseases as well increase their quality of life, an application of public involvement and participation metrics.

He manages his profession and advocacies in providing quality healthcare and wellness on the individual level, organizational level (corporate: Nutra, Pharma Healthcare, ICT-BPO, Distribution-Logistics, Hospitality Tourism, Schools, Retail, Real Estate-Development), and city levels. He has served through establishing programs and multi-medical system centers from Northern Luzon (La Union) down to Quezon City and as way South to Bicol’s Legaspi. For this reason he was given awards and recognition in the City Levels especially when disasters struck, Asian Achiever award in Naturopathy and Dangal ng Bayan Award.

Notably, he has successfully aided in the reversal of hypertension, cardiac insufficiency, diabetes, atherosclerosis, arteriosclerosis, chronic kidney diseases and the like through using combined whole medical systems and integrative medicine methods- Holistic Medicine.

To date, he holds a Diplomate in Naturopathy and Energy Medicine in the IFP, First Filipino Diplomate in Whole Medical Systems and Diplomate in Integrative Medicine in the American Association of Integrative Medicine. Furthermore he holds an International Membership with the World Society of Interdisciplinary Anti-aging Medicine, membership with the Philippine Stem Cell Society, membership with the Philippine Institute of Environmental Planning, membership in the Philippine Society of Biochemistry and Molecular Biology, Registered Triathlete with the Triathlon Association of the Philippines and was granted membership in the prestigious American Board for Certification in Homeland Security. He believes security in health is affected by the quality of security we have at home and in our homeland. Security about Him and for Him, is another story to be shared.

He serves the movers and shakers in the Philippine society in the areas of private and public hierarchies including key positions in law enforcement, congress, business and humanitarian. John Paul the II had a noble heart and this has inspired Dr. Pao in his vocation and profession to help one and all: “Live a Legacy”.


The Flu and Prevention

The Flu and Prevention

Published April 14th, 2015 in Alternative PerspectiveAlternative Therapies

by Tammera J. Karr, PhD

This year, that flu “vaccine will only reduce your risk of ending up in the doctor’s office with the flu by about 23 percent. The vaccine was developed nearly a year ago in February, 2014, and it’s not an ideal match for H3N2, the strain of the virus prevalent this season. That mismatch — along with H3N2’s reputation for causing higher hospitalization and mortality rates — led the Centers for Disease Control and Prevention to predict a severe flu season this year.

That prediction has been borne out, with more flu-related doctors’ office visits this year than last year. In Virginia, flu activity remains high after peaking in late December, according to the state health department. As the air gets drier, it sucks the moisture out of those mucus droplets. As the droplets shrivel and crystallize, the reduction in water increases the concentration of salts and proteins and changes the acidity.” (http://www.sciencedaily.com/releases/2015/02/150202105403.htm_br)

Linsey Marr, a professor in the Charles E. Via Jr. Department of Civil and Environmental Engineering at Virginia Tech, is obsessed with flu transmission. “Marr found that between 50 percent and 98 percent humidity, the virus doesn’t survive well — the droplets dry out just enough to be inhospitable. But at very low humidity — like you’d find indoors in the winter — droplets can dry out completely, preserving the virus-like microscopic beef jerky.”

“As recovering flu victims struggle back to work and school, and new cases keep cropping up, the question on everyone’s mind is: What can people do about it?”

  • Washing your hands, is a start, and then there is the tried and true home remedies of garlic, onions, bone broths and a diet rich in real foods versus processed foods.
  • Optimal vitamin D3 levels (optimal levels fall between 65ng/ml & 85ng/ml), vitamin C rich foods and naturally fermented healthy bacterium rich foods, also improve your ability to ward off viruses. If you can’t handle fermented foods increase your probiotic supplement use.
  • Getting out from under florescent lights also improves your body’s ability to fight viruses, along with the use of cheap air filters to reduce airborne molds and dander that weaken your immune response.
  • Use a humidifier on your wood stove to improve the humidity during flu season in your home.
  • Change out air filters in your heating system even if you think they don’t need it to improve air quality in your work and home.
  • And lastly, a good night’s sleep makes a world of difference. You should wake feeling rested, not run over by a truck. If you don’t feel rested consider your bed may be the problem before you run off to the doctor for a sleeping pill.

To Your Good Health and Information –

Sources

http://www.newswise.com/articles/reasons-why-winter-gives-flu-a-leg-up-could-be-key-to-prevention_truncated

Reasons Why Winter Gives Flu a Leg Up Could Be Key to Prevention. (n.d.). Retrieved from http://www.newswise.com/articles/reasons-why-winter-gives-flu-a-leg-up-could-be-key-to-prevention_br
Reasons why winter gives flu a leg up could be key to … (n.d.). Retrieved from http://www.sciencedaily.com/releases/2015/02/150202105403.htm_br


Depression School: A 3-Session Group Crisis Stabilization Intervention

Depression School: A 3-Session Group Crisis Stabilization Intervention

Jolene Oppawsky, PhD, LPC, ACS, DAPA
University of Phoenix

Abstract

The rapidly changing mental health care environment has many treatment and financial implications for therapists and clients.  The changes place new and acute demands on providers and caregivers to meet clients’ needs with time-limited, innovative therapies without compromising care.  Innovative perspectives in clinical practice should stimulate research on practical therapeutic interventions developed by clinicians who depend on their own creativity and resourcefulness to help clients.

In this article, we present the process and protocol of Depression School, an innovative 3-session depression group for crisis stabilization of depressed clients.  Also included are examples of the clients’ written work, a tangible form of accountability, the results of a before-and-after Beck Depression Inventory taken by each client as evidence of the initial depth of depression and successful treatment.

 

Introduction

The rapidly changing mental health care environment has acute implications for therapists and clients.  The number and nature of authorizations for therapy have changed.  Due to economical considerations, authorizations of brief treatment models, with a reduction of the number of therapy sessions, have increased.  There has also been an increase in authorizations for group therapy, although the evidence that group therapy is more cost effective than individual therapy is still debated (McCrone, A. et al, Shapino, J. 1982, MacKenzie, C. & Ray, K., 1995, Tucker, M. & Oei, T. P.S. 2006).  Additionally, hospitalization authorizations by HMOs for mental health problems have decreased.  These changes place new and acute demands on therapists to meet their clients‘needs without compromising care.

It is far beyond the scope and purpose of this article to review the ever-growing amount of financial research and clinical-use literature on the above topics.  It is the author’s hope that this perspective in clinical practice will stimulate research on practical therapeutic interventions developed by clinicians who depend on their own creativity and resourcefulness to help clients.

In the following article, this author and facilitator of the group presents the instructions and process for facilitating a 3-session depression group and gives the protocol for facilitating the group.  The group, whose members were selected by the intake therapist, agreed to participate in this innovative crisis stabilization treatment.  The group was named Depression School by the initial clients, and the name stuck.  The group members met weekly for crisis stabilization of their depression before they were transferred to five sessions of individual therapy.  Also included in this article are examples of the clients’ written work and a tangible form of accountability, the results of a before-and-after Beck Depression Inventory ( Beck, A. T., Rial, W. Y., & Rickets, K. 1974;  Burns, 1992 ) taken by each client as evidence of the initial depth of depression and positive treatment outcomes.  An additional bonus is that the clients can use this instrument at home to gauge their moods and ward off depression.

After the 3-session group, the clients participated in five weekly sessions of individual therapy as a time-limited treatment and were then discharged.  Treatment was completed in eight weeks (60 days).

Depression School

Building the Group

Depression school is a name coined by the first group of clients who participated in a new and innovative three-session crisis stabilization group therapy model for depression as part of an eight-session therapy plan developed by this author, as a time-limited treatment.  The remaining five sessions were individual sessions.  This name, Depression School, has been accepted by all subsequent groups conducted by this therapist/writer resulting in a permanent name for this writer’s groups on depression.  The group members can be a mix of ages, races and sexes, or women’s and men’s groups can be formed.  Groups of children and adolescents can also be established.  Extremely psychotic clients would not be appropriate for this model because of the level of group participation necessary to make the workbooks and interact effectively with the other clients in developing their own treatment.

The Beck Depression Inventory

BDI usage

The BDI is actively used today in numerous statistical efficacy studies, among many others, (Enrichd Investigations, 2003; Thompson, L.W., Coon, D. W., Gallagher-Thompson, D., Sommer, B.R., & Koin, D., 2001).

BDI results in Depression School are gathered to judge therapy outcomes and to help the clients use this instrument at home to gauge their depression if they are using The Feeling Good Book (Burns, D., 1992).  The intent of using the BDI in Depression School is not to obtain statistical data, but rather to be used at home by clients to help make them active participants in their treatment.  It also gives them a preventative tool to help them manage their moods.

Each client should have two scores, one score from the beginning of therapy, and one after the third session.  Each client’s BDI results are put on individual graphs and added to their workbook.

The Process

The group’s goal was established by this therapist/writer, that of understanding, managing and defeating depression through group effort, and the objectives were defined.

Group objectives

  • To gain an understanding of depression and develop a group definition of depression
  • To explore, as a group, your old ways of handling depression that have not been helpful (“bummers”)
  • To understand, through group sharing, the circumstances that brought you to therapy
  • To develop and explore, as a group, new ways of dealing with depression
  • To try these new ways in real life

 

Session one

The first session starts with an introduction by the therapist about his or herself and about the upcoming group work, followed by an invitation for the clients to introduce themselves and make a short statement about what they would like to accomplish individually and as a group.  The Beck Depression Inventory (BDI) is then explained and given to each client.

After the BDI is taken, the clients are asked to described their depression to the group, generate a group definition, and develop a motto.  Clients also share with the group what happened in childhood and along life’s way to set the stage for depression.  The therapist, co-therapist or selected group member should record the definition and motto.  Recording a few key words of the clients’ descriptions of depression and what happened in childhood is also necessary.  After generating lists of current and childhood experiences, which the clients feel caused their depression, the group members extract main themes from the information.  The designated scribe also records these.  These records are then used in the development of the group’s workbook.  Computers may be used, which are especially welcomed and effective when working with teenagers.  This means that client writings are generated right in the group.  Kelly (1990) and Oppawsky (2001) suggest that client writings in therapy can enhance cognitive awareness for clients.  For homework, the clients are asked to think about how their workbooks could be embellished with art work, photographs, or poems, and to bring anything they would like included in their workbooks to the next session.  The process of this type of group usually initiates a significant amount of group interaction and the clients are asked to give and receive feedback and support from their peers.  Personal items help clients share personal information and help them discover or elaborate on any negative or positive thoughts.  The clients are encouraged to discover the universality of any items brought in for their workbooks, such as a photograph of a client as a child laughing, playing, or with siblings or family, or of a pet.  This task helps clients discover just how well they can identify with others.  This connectivity also helps bridge social and cultural lines leading to positive cross-cultural interactions within the group (Oppawsky, 2009).

Session one should close with an exploration of any issues arising from the session and a safety check, meaning a danger-to-self and a danger-to-others check and an affirmative statement from each client about him or herself.

Session two

The group opens with a short round-about with each client telling about his or her week.  Then, clients are invited to explore old ways of dealing with depression that have been counterproductive or have not worked, and generate a bummer list.  The word bummer to describe this list was client-initiated, and has stuck.  This part of the group work usually generates significant interaction among members and this interaction should be encouraged.  Again, the bummers are recorded for the workbook.

After the bummer list is generated, the group is invited to explore and develop new ways of dealing with depression and to generate a new ways list.  This list may be made up of things that have worked for the clients in managing their depressive moods in the past, or things that they would like to try.  Accepted cognitive behavioral techniques, such as negative thought stopping, journaling, and identifying triggers that lower moods, can be introduced by the therapist (Corey, 2001).  These are also recorded for the workbook.  After generating the new ways list, each client contracts to try a new way in vivo in the next week.

Again, session two closes with an exploration of any issues arising from the session or during the week, a safety check, and an affirmative statement by each client about him or herself.

Session three

Session three starts with group members sharing how they made out using new ways during the past week.  This usually generates significant group interaction.  Group support is imperative if some of the members were not successful in adopting a new way.  If a client was not successful, the client selects another new way to be tried in vivo in the following week.

Clients are then asked to retake the BDI and compare their results to their initial BDI.

A group discussion of their results follows, again with group and therapist support if  a client’s mood has not improved, and encouragement and support if it has improved.

The clients are then asked to make their workbooks with supplies usually provided by the therapist and/or agency.  Some supplies that are useful are colored construction paper for the cover and yarn or colored thread to bind the workbook.  The clients often bring pictures or poems to develop cover pages.  Often, pictures are included inside the workbook, as well.  Children and teenagers like to put their own pictures on the front of their workbooks or draw a cover picture.  This writer usually generates copies of the individual BDI results, the objectives, the group motto, the bummer list, and the new ways list on the computer and then provides them to the clients for their workbooks.  Frequently, a group member will do this as homework.

The group closes with each member giving another member a positive affirmative of something he or she has observed about the member during the three weeks.  An exploration of any issues arising from the group or during the group’s duration follows.  A safety check is made, and the clients are transferred to their individual therapists for their remaining five individual therapy sessions.  The group members are encouraged to take their workbooks with them to their first sessions of individual therapy.

Suggestions for Follow-up

Each client is transferred from Depression School to individual therapy.  After five sessions of individual therapy, all clients are usually discharged having attained their treatment goals and with moods that are continuing to improve.  The clients are asked in individual therapy to make a commitment to monitor their moods at home and continue using the new ways developed in Depression School in individual therapy and after discharge.  The clients are usually encouraged by the individual therapist to join a self-help depression group or a bereavement group in the community.  A list of community resources should be given.

Contraindications

Therapists should initially assess the clients for danger to others and/or dangers to self.  These assessments should be done throughout the duration of therapy as well.  Clients who are suicidal, or have vague threats of harming others, can participate in this innovative model with proper precautions such as no-suicide and no-harm-to-others contracts.  Clients who have active intentions to harm themselves or others are not appropriate for this group.  Clients who become seriously suicidal in the group with a plan and/or means to commit suicide, or trigger a Tarasoff response, should be referred out of group to appropriate services.  Occasionally, some clients may experience deepening depression or mental decompensation while in group and should be transferred immediately to more intensive care.

Vignette Protocol of a Depression School Therapy

The following is the protocol of an authentic Depression School that includes the group’s definition of depression, the motto of the group, the themes from the group, the bummer list, the new ways list, and the results of the BDI, pre and post-treatment.

Client Selection

All the eight participants – five women and three men of different ethnic backgrounds, White, African American, and Hispanic, and ranging in age from 25 to 58 – had a psychiatric diagnosis of Major Depression, severe or moderate, determined during his or her biopsychosocial intake assessment at an outpatient crisis intervention and brief treatment facility.  All participants had denied suicidal ideation or homicidal ideation during intake.  All clients had had previous suicidal ideation but had made no attempts.  Some had had vague thoughts of harming others in the past but with no plan or intent.  All signed no-harm contracts.  All the participants had refused medication.  Each client was granted eight sessions of brief treatment by his or her mental health provider and agreed to participate in this innovative plan for therapy.

The group’s definition of “a depressed person” was: “one who is not able to deal with things in life, who feels down all the time, who is not able to make decisions, has mood swings, is angry, who is tired all day, and wants to kill/hurt someone.”

Their mottos were: “Find your own life,” and “Depressed people are sensitive, we feel, it hurts, it is risky – but we wouldn’t have it any other way, but without depression, look inside, listen to self.”

After generating lists of current and childhood experiences, which the clients felt had caused their depression, main themes were extracted from the list by the group members.  The following themes were generated by the group:

  • Loss of love
  • Loneliness
  • Financial problems
  • Threatened autonomy
  • The need for unconditional love, unconditional acceptance

Bummers

A bummer is something used to try to deal with depression that has not worked.  Sharing bummers with each other helped the group avoid unsuccessful coping methods.  Group support also helped clients relinquish steadfast bummers.  The following were examples of bummers generated by the group.

  • Drinking and drugs
  • Not crying
  • Anger – gets you nowhere
  • Letting people back/drive you into a hole, not standing up for yourself
  • Denial
  • Sleeping all the time, boredom
  • Hurting yourself or others
  • Fighting and domestic violence
  • Losing sight of yourself and your needs
  • Hooking up with people or getting married to someone you don’t love out of feelings of being needy
  • Making wrong decisions
  • Settling for less
  • Not being able to accept reality
  • Letting depression immobilize you
  • Running from a situation
  • Setting yourself up for bad things
  • Engaging in work activities that don’t have anything to do with your dream, staying in a bad job, or poor work atmosphere
  • “Absorbing shit” instead of dealing with people

New ways

The new ways list contained examples of things that group members had successfully used   in the past to manage and defeat depression, or ones they wanted to try.  Each client selected a new way from the list and made a commitment to try a new way between the second and third session.  Each client also committed to relinquishing his/her bummers and using new ways during individual therapy and after discharge.  The new ways were:

  • Crying and grieving, grief work
  • Activities such as music, church, art, reading helpful and powerful books, hobbies, fitness, participating in groups, such as Divorce Recovery or Parents without Partners
  • Do something innovative despite not having the money
  • Validate yourself and your feelings, don’t let yourself be put on the back burner (take affirmative action)
  • Reach out to others
  • Make a plan and carry it out
  • Take time out for yourself , enjoy time to yourself

BDI  results

The BDI results were gathered to judge therapy outcomes and to help the clients use this instrument at home to gauge their depression if they were using The Feeling Good Book.  Each client had two scores, one score from the beginning of therapy, and one after the third session.  All the clients were in the moderate, severe, or extreme depression categories initially except one client with mild mood disturbances.  All responded to the therapeutic effects of this group intervention with improvement in mood.  Six out of eight clients showed more improvement in mood on inventories than the other two.  The client who scored in the mild mood disturbance category reported that she was feeling better, and her score did not rise within the category.  Each client’s BDI results were put on individual graphs and added to their workbooks.

Discussion of Depression School and the Vignette

The Beck Depression Inventory (BDI) was designed as a standardized tool to assess the depth of depression and is widely used throughout the United States and Canada as well as abroad (Corey, 2001).  It is a formal screening tool for depression with good reliability and validity (Beck, Rial, & Rickets, 1974).  A review of evidence-based studies shows that both the BDI and the BDI-SF (Short Form) are used (McFarland, K., 2005).  The BDI and the assessment scale are published in Burn’s (1992) self-help book, making it an accessible and affordable resource for clients.  Many clients come to therapy with the book or have the book at home.  Many mental health centers have the book available for clients and therapists to use, and it is also readily available in most public libraries.

In Depression School, the depth of depression for each client was assessed in the first few minutes of therapy.  The initial results stressed each client’s reality without disputing or prescribing their symptoms.  The final BDI was a tool of accountability of therapy, a tangible product of what really went on in therapy, as well as a measure of positive outcome.

The rapidly changing mental health environment, in which the number of therapy sessions is reduced, should awaken therapists to a need for innovative and new ways to increase the effectiveness and efficiency of therapy, as well as aid in the accountability of therapy without compromising care.  Enrolling depressive clients in crises in a weekly 3-session Depression School for crisis intervention and stabilization before they are transferred to individual therapy is warranted.

In Depression School, clients were viewed as active agents who were able to derive meaning out of what they were going through and were helped to take action to modify their depression.  Their written work and BDI results enriched this model by encouraging processes of self-expression, which were documented.  Additionally, clients’ written work helped the clients understand their therapy and the therapeutic process.  Their workbook became a tangible form of accountability for them.  The universality of the group members’ problems and their interactive approach to understanding, managing, and defeating their depressions helped the clients to acquire effective strategies in dealing with their moods in a timely fashion.  Indeed, all clients in the vignette, except one with initially mild mood disturbances who retained the same results, showed improvement.  Six clients out the eight showed more improvement in their moods than the other two.  Depression School, as a crisis intervention/stabilization therapy, with its goals of helping clients understand, manage, and defeat depression, worked for these clients.  By divorcing themselves from bummers and using new ways, the Depression School actually became a coping skills program for clients in crisis and paved the way for successful individual therapy.

After the three sessions, the eight clients who participated in the group and were presented in the vignette were transferred to five sessions of individual therapy, wherein the clients’ problems past and present problems leading to depression were explored in depth.  Their commitments to understanding, managing, and defeating depression were reaffirmed.  All the clients’ BDI scores improved by the end of the three sessions with the exception of the one client whose BDI showed mild mood disturbances initially.  Her BDI stayed in that range.

At the time of discharge, after eight sessions (3 group sessions and 5 individual sessions), all clients were in the mild mood disturbances range of the BDI, substantiating significant improvements in their moods.  The one client who was in the mild mood disturbance range initially reported that she felt significantly better having moved higher within her range.  The clients were discharged by mutual client/therapist agreement with treatment completed.

Research Possibilities and Multiplication Factors

Serious psychotherapy is a blend of art and science.  Experienced therapists understand that the need for brief treatment modalities calls for creative and innovative interventions.  These therapists also know that they must use what works.  This model of treatment was designed by this writer from her significant experiences practicing psychotherapy in agency settings in Arizona, where resources and the number of sessions allowed to clients are limited.  The use of this innovative and creative practice illuminated the need for research on this group model.  It is the author’s hope that this perspective in clinical practice will stimulate research on practical therapeutic interventions developed by clinicians who depend on their own creativity and resourcefulness to help clients.  For example, on this group model, statistical tests on the results of the BDI could be done to determine if the changes the clients’ recorded were statistically significant.  The number of group sessions compared to individual sessions was arbitrarily picked by this writer based on her experience with and need for brief therapies.  Further research on the exact number of group versus individual sessions needed to stabilize moods could be researched.  Furthermore, the use of this model with children and adolescents could be practiced and researched.

This writer has since successfully conducted many 1-3 session Depression Schools with medicated and non-medicated adult clients with major depressions, dysthymia, and bipolar disorder.  After stabilization, these clients were transferred to various services, such as meds only groups, case management services, primary care physicians, self-help groups, and to individual therapies of different lengths of time.

 


 

References

Beck, A. T., Rial, W.Y., & Rickets, K. (1974). Short form of depression inventory: Cross-validation.  Psychological Reports, 34(3), 1184-1186.

Burns, D.  (1992). Feeling good  The new mood therapy.  New York: Avon Books.

Corey, G. (2001). Theory and practice of counseling and psychotherapy.  Pacific Grove, Ca: Brooks/Cole Publishers.

ENRICHD Investigators. (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The enhancing recovery in coronary heart disease. Patients (ENRICHD) randomized trial.  Journal of the American Medical Association, 289, 3106-3116.

Kelly, P.  (1990).  The uses of writing in psychotherapy.  New York:  Haworth Press.

MacKenzie, C. & Roy, K. (Eds.), (1995). Effective use of group therapy in managed care.  American Psychiatric Publication on Clinical Practice No. 29. British Columbia: Clinical Practice Publisher.

McCrone, P., Weeramanthri, T., Knapp, M., Rushton, A., Trowell, J., Miles, G. Kolvin, I.  (2005). Cost-effectiveness of individual versus group psychotherapy for sexually abused girls. Child and Adolescent Mental Health, 10(1), 26-31.

McFarland, K., (2005). Battling late-life depressions: Short term psychotherapy for depression in older adults-A review of evidence-based studies since 2000.  Annals of the American Psychotherapy Association, 8(4), 20-27.

Oppawsky, J. (2001).  Client writing: An important psychotherapy tool when working with adults and children.  Journal of Clinical Assignments, Handouts, and Homework in Psychotherapy Practice, 1(4), 29-40.

Oppawsky, J. (2009). Grief and bereavement. A how-to therapy book for use with adults  and children experiencing death, loss and separation. Bloomington, IN: Xlibris Press.

Shapiro, J. ( 1982). Cost effectiveness of individual versus group cognitive behavior therapy for problems of depression and anxiety in an HMO population.  Journal of Clinical Psychology, 38(3), 674-677.

Thompson, L.W., Coon, D.W., Gallagher-Thompson, D, Sommer, B. R., & Koin, D. (2001). Comparison of desipramine and Cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression.  American Journal of Psychiatry, 9(3), 225-240.

Tucker, M. & Oei, Tian P.S. (2006). Is group more cost effective than individual cognitive  behavioral therapy?  The evidence is not solid yet.  Behavioural and Cognitive Psychotherapy, 35(1), 77-91.

 


 About the Author

Oppawsky_JoleneJolene Oppawsky, PhD, a Diplomate Psychotherapist, Licensed Professional Counselor in Arizona, and an Approved Clinical Supervisor is a University of Phoenix faculty member and supervisor in the graduate counseling program in Tucson, Arizona. Formerly, she taught for Boston University in their graduate overseas counseling program. She has taught psychology and psychotherapy at the University of Warsaw twice and at the University of Lithuania. She does psychotherapy on a contract basis in Tucson, Arizona. She has several professional publications to her credit.


The Use of Hypnosis in the Treatment of Migraine Headache: A Case Study

By: Edward Mackey CRNA, MS, MSN, Ph.D.

Assistant Professor

West Chester University of Pennsylvania

Abstract

Migraine headaches significantly impact the lives of those who suffer from them.  This case report discusses a patient suffering from frequent and almost incapacitating migraine headaches that lasted over a period of fifteen years and were unrelieved by conventional methods.  Here I present my experience with this patient utilizing hypnotherapy techniques as an adjunct to her pharmaceutical regimen.  The patient participated in a once weekly, hour-long session of hypnotherapy.  After weekly hypnotherapy for a period of two months, the patient reported definite improvement, a decreased number of migraine headaches, and was feeling more comfortable with using self-hypnosis.  It is interesting to note that after eight sessions of hypnotic intervention, the patient improved drastically.  The patient remains migraine-free ten months after her last office visit.  The patient has consented to allow presentation of this case material.

Keywords: Migraine Headache, Ideomotor Movement, Self Help, Brief Focused Therapy

Learning Objectives:

1)      The reader will understand the use of ideomotor questioning in hypnotic interventions,

2)      identify differences in direct suggestion and indirect suggestion,

3)      and identify a method of inducing glove anesthesia.

 


 

Introduction

            Migraine headaches are vascular in origin, yet they are often mixed with components of tension headaches as well.  In fact, up to half of patients with migraine headaches also meet the criteria for tension headaches.  These patients are labeled “mixed migraine and tension headache” (Crasilneck & Hall, 1985; Barabasz & Watkins, 2005; Turk & Garchel, 2002).   Migraine headaches can be episodic, with attacks lasting anywhere from several hours to several days or a week.  They are frequently accompanied by nausea and vomiting, as well as sensitivity to light and sound (Turk & Gatchel, 2002).  Psychotherapeutic interventions for migraine headaches as well as headaches in general are only used when other physical or organic factors such as tumors or chronic sinusitis are ruled out.  Once other causative factors are ruled out, psychogenic factors involved in migraine or tension headaches seem to respond well to hypnotherapeutic initiatives (Andreychuk & Skriver, 1975; Barabasz & Watkins, 2005; Blumenthal, 1963; Graham, 1965; Kroger, 1977; Olness & Kohen, 1996).  Hammond (2007) reviewed the efficacy of clinical hypnosis with headaches and migraines, and his paper provided an up-to-date review of the literature on hypnotherapy.  He concluded that it was “efficacious, virtually free of side effects, risks of adverse reactions, and ongoing expense associated with medication treatments” (Hammond, 2007, p.207).  Directive hypnotherapy has been used successfully with premenstrual migraines and premenstrual tension (Kroger, 1977).  Self-hypnosis training was shown to be effective in reducing the frequency of headaches in children ages 6-12 years with classic migraines (Olness, MacDonald & Uden, 1988).  Using suggestion and imagery so the patient can visualize his or her extremities warming, direct suggestion has been used to redirect blood flow and create vasodilatation in the peripheral vasculature, which decreases blood volume in the brain and alleviates the migraine headache (Barabasz, 1977; Barabasz & McGeorge, 1978).  Bassman and Wester (1997) devised an integrative approach to headaches and pain control using a four-session approach to alleviate discomfort through the use of hypnosis, glove anesthesia, metaphor, and direct and indirect suggestion.  This provided practitioners with a workable program to use with patients with headaches and other discomfort.  This case study outlines a process of hypnotherapeutic intervention including ideomotor questioning, the teaching of self-hypnosis to the patient, guided imagery, and post-hypnotic suggestion to work in conjunction with the patient’s current medical regimen.

Case History

Johanna Marx (not her real name), a mother, wife, graduate student and OR nurse was originally diagnosed with migraine headaches when she was 30 years old.  JM is now 45 years of age.  JM had heard of my work in hypnosis with patients suffering from headache and migraines in particular and had decided to seek my assistance after thinking, “I am at the end of my rope.”   During the intake session, JM told her history of incapacitating headache pain associated with nausea and vomiting, as well as sensitivity to light and sound lasting from hours to several days.  These incapacitating headaches would impact both her personal and professional duties.  She found herself using an inordinate amount of sick time at work, and at home she found she was unable to perform activities required of a busy mother and homemaker.  She had suffered from “severe headaches” for a number of years prior to being officially diagnosed by her primary physician at age 30.

Medical History:  30-year-old female in no acute distress (NAD) with exception of frequent debilitating attacks of migraine headaches.  Her medical history at age 30 revealed hypertension with blood pressure ranging from 140-150’s systolic over 90’s diastolic.  The medical record revealed no psychological or psychiatric diagnosis or distress.  JM stated her Marriage was “fulfilling” and “very satisfactory” with no evidence of any sexual dysfunction or concern. Regular monthly menses with frequently associated migraine events were reported.  With the original diagnosis, JM was prescribed Percocet as needed (PRN) for headache.  JM mentioned there was no suggestion on any dietary modification or discussion on other treatment modalities given at that time by her physician.  JM intimated that: “I would not take the Percocet so I concentrated on the Dunkin Donuts plus Advil route.”  When asked what she meant, her reply was: “I did not like the way [the Percocet] made me feel, so I used caffeine and Ibuprophen.”

JM started to have more frequent headaches and went to see another physician who prescribed Imitrex nasal: 5mg and Ultram 50 mg. p.r.n. for headache pain, which seemed to work well for awhile and also did not make her “goofy,” in her own words.  She was also started on Toprol 50 mg BID for hypertension (HTN).  A few years later, when the headaches continued to get worse, her new primary physician referred her to a neurologist who did a complete workup, and as the headaches progressed, started her on Relpax (Eletriptan Hydrobromide) at 20 mg at the onset of migraine, repeated in two hours if there was no relief.  The Relpax gave her chest pain, which was then investigated with stress echocardiogram, which showed nothing abnormal.  Her physician then started her on the following medication regimen:

    • Imitrex (sumatriptan) nasal 25 mg p.r.n. at onset
    • Reglan (Metoclopramide Hydrochloride) 20 mg p.o. at onset
    • Celebrex (Celecoxib) 20 mg q. am
    • Verapamil 240 mg BID (instead of the Toprol; yes this dosage is correct)
    • Naprosyn (naproxen) 2 tabs prophylactic ally 2 days prior to onset of menses
    • Compazine (prochlorperazine) 25 mg PR if needed
    • Prednisone on a 4 –day pulse: 80-40-20-10 mg/daily

JM reported that within a short period after starting on this regimen, things were better.  Then, however, she had two episodes of intractable migraines, the first lasting 21 days with expressive aphasia and the second lasting 17 days without any aphasia.  Her physician then changed the Imitrex to Migranal (dihydroergotamine mesylate) nasal spray, with up to four sprays in each nostril as needed.  In her own words, JM stated: “at the peak of these headaches in 2007-2008, I had quite an arsenal of meds that I felt I needed to carry in my purse.”

At the start of our work together JM was currently 45 years of age, 15 years after the original diagnosis of migraines.  Her medication list was as above: Migranal, Reglan, Celebrex, Verapamil, Naprosyn, Compazine, and Prednisone.  JM was not taking any other medications or supplements except for a daily multivitamin.  JM was not taking any oral contraceptives except during the first few years of her twenties.  She preferred other methods of birth control, as she had been aware of estrogen-progestin combinations (oral contraceptives), a possible link to headaches and migraines in particular (Abrams, 2006).  JM exercised through daily 30-minute walks with her dogs.  She had been married for 20 years to the same spouse and rated the quality of her relationship as five on a ten-point scale.  JM reported frequent (2-3 times per week) discomfort in her joints.  She denied depression, anxiety, mood swings, repetitive thoughts or obsessions, homicidal thoughts, or suicidal ideation.  JM denied alcohol/drug abuse, eating disorder, learning disability, or trauma/abuse.  JM’s score on the Beck Depression Inventory (BDI) = 7.

Family history included:        Father – depression

                                                     Mother – anxiety disorder

                                                     Sister – depression

JM considered herself an intelligent person, willing to work hard and follow through on projects, and she believed she had a good support system of her spouse and friends.  JM was “hopeful” that hypnosis/hypnotherapeutic interventions would help her gain some relief over her migraine attacks.

Description of Treatment

First Session

After filling out the H&P as well as other usual intake forms, JM and I discussed hypnotism, what are its uses in medicine and psychology, along with a discussion on commonly held misconceptions regarding hypnosis. All misconceptions regarding the use of a hypnotic intervention for JM were debunked.  JM was hypnotized using Chiasson’s technique and then deepened using a Fractionation technique.  Chiasson’s technique involves instructing the patient to place his or her hand in front of his face with his palm facing away and the fingers held together about one foot away from the face.  This position places a natural strain on the fingers to begin to spread, and when accompanied by suggestion, it can be enticing to the patient to “let go and enter the hypnotic state.”  Fractionation is a deepening technique utilizing arousal and reinduction of trance with each subsequent reinduction helping the patient to go deeper or further into hypnotic trance.  JM was given suggestions to draw her attention to the “hypnosis chair” she was reclining in and to “feel the comfort and safety of the hypnosis chair supporting her.”  JM was then given suggestions that if at any time during hypnosis she felt uncomfortable or unsafe, then she could immediately return to her safe place in the hypnosis chair.  Ideomotor finger signals for yes-and-no responses were established using her right index finger for “yes” and her right thumb for a “no” response, as well as an “I don’t know” response indicated by her right little finger, as recommended Brown, Scheflin, and Hammond (1998).  These finger signals were tested using quick response question and answers about time, place, and person.  Ideodynamic or ideomotor signaling methods date back to antiquity; it was utilized frequently by Milton Erickson during his early career in hypnotism (Mackey 2010).  Finger signaling (ideomotor movement) was described and streamlined by David Cheek and Leslie LeCron (Cheek & LeCron, 1968), and more recently by others (Ewin & Eimer, 2006).  A post-hypnotic suggestion (PHS) was given to JM to “allow her to rapidly go into hypnotic trance and go much deeper than before whenever I lifted her right hand and dropped it on the armrest of the hypnosis chair.”  JM was asked if this would be alright with her and she responded by raising her right index finger in a tremulous fashion.  JM was asked whether it would it be all right for her to have fewer migraine headaches and perhaps let go of all migraine headaches in the future.  Her right index finger rose, indicating a yes response.

Self-hypnotic technique was taught to JM and then rehearsed in hypnotic trance.  This technique included suggestion to raise her right index finger and hold it in place as she began slowly counting backwards from the number ten.  Suggestions were given that as each number is mentally recited, she could feel her finger getting heavier and moving downward, and that by the count of one her finger would have moved all the way down, and she would be in the familiar relaxing place she knows as trance.  Following self-hypnotic instruction, JM was given direct suggestion hypnosis (DSH) suggestions “that whenever you feel that familiar feeling you have prior to the onset of your migraine headache you will immediately begin to relax and warm the fingers of both your hands.”  Imagery of “turning on the faucet in your arms will allow more blood to flow into your hands and fingers allowing them to become very warm” thus “decreasing the discomfort in your head.”  JM was also given indirect suggestion hypnosis (ISH) via metaphor to increase her sense of comfort and relaxation throughout the day.  During post-hypnotic interview, JM reported that she definitely felt she was hypnotized and felt very relaxed during the trance.  She stated, ”I remember pretty much everything you told me.”

Second Session

A review of the prior week’s activities and self hypnosis practice was conducted prior to the formal hypnosis session.  JM reported that she had several migraines during the week but that they were not the usual duration and none lasted longer than 36 hours (an improvement per JM). She reported that she was using her self-hypnotic techniques on a daily basis to place herself in trance several times per day.  JM was asked if there were any other changes to her normal diet or medication protocol, to which she said no.

JM was directed to sit in the hypnosis chair, and when she was asked if she was ready to do some more hypnosis, she readily agreed with a handshake.  At that time, I dropped her arm on the armrest of the hypnosis chair, and JM went into trance (utilizing the post-hypnotic suggestion given to her at the previous session).  JM was deepened using an eyes-open, eyes-closed fractionation technique.  DSH was given to JM regarding using her hand and finger warming techniques anytime the “familiar sensations” began heralding the onset of a migraine.  ISH using analogies of “not knowing when you were hurt until sometime after the initial injury,” like “when you may have had a paper cut and did not realize it until much later” were given to JM along with suggestions that the same mechanism of “not feeling discomfort” were anchored to  specific words, “relax, relax, relax.”  JM was given a PHS to “not feel discomfort” by immediately using her self-hypnotic technique to enter trance and imagine herself on vacation. Direct suggestion was given “to see yourself as you desire to be… free from migraine headache… comfortable… at ease… in control… safe and secure.”  She emerged from trance, and during post-hypnotic interview mentioned that she did not recall as much about the session as she had the previous week.

Third Session

            JM reported she had used self-hypnosis to “see” herself on the beach when she had the familiar aura prior to getting a migraine.  She stated that “I did not have any migraine headache after using this technique but did have two migraines lasting 24 hours when I was unable to use the technique at work.”  JM reported that she was pleased that she had some control back in her life, and that she felt the hypnotic interventions were definitely working.  JM was directed to sit in the hypnosis recliner and an arm drop induction was utilized along with fractionation to deepen trance.  JM was taught glove anesthesia using imagery of an “ice bucket filled with ice cold water as cold as cardioplegia solution used in open heart surgery” alongside the recliner. This suggestion of “carioplegia solution” is a familiar term to JM, an Operating Room nurse with experience in Open Heart Surgery where cardiolplegia (an ice bath of various chemicals) is utilized to cool the heart muscle quickly and still the heart from beating.  JM was taught to imagine placing her hand into the solution and “feeling the numbness” begin and grow in her hand as it became colder and more numb.  She was then tested for anesthesia with application of hard pinch to the posterior surface of her hand.  JM was instructed to open her eyes and remain deep in trance.  She opened her eyes and the same hard pinch was administered to the posterior surface of her hand.  Her face remained expressionless as her hand was pinched.  JM was given DSH that she could give herself Glove Anesthesia during self hypnosis and then place her anesthetized hand to her head anytime she felt the migraine pain.  She was asked if this would be alright with her, and her right index finger rose slowly and in a tremulous fashion.  Hartland’s ego-strengthening suggestions were given along with a suggestion that when she is doing self-hypnosis and in trance, her right hand will slowly rise and then fall, deepening her trance.  She then emerged.  During post-hypnotic interview she stated, “I did not even feel you touching my hand,” when asked about any sensations felt during the trance session.

Fourth Session

Review of the previous week showed JM not having any migraine attacks.  “This is the first week in years that I have not had a migraine or headache of any kind” and “I am thrilled and pleased beyond imagination.”  JM was asked to have a seat in the hypnosis chair and place herself into a self-hypnotic trance.  After watching her right index finger rise and fall, therapeutic metaphor was used to suggest changing unpleasant circumstances and feelings into more pleasurable experiences.  Ego-strengthening suggestions were given and DSH was used to reinforce previous suggestions of glove anesthesia and also “…all these suggestions we have given you will remain with you and become stronger for as long as you desire them working in your life…” JM was emerged and during post-hypnotic interview, she recalled no specifics about the session.

Session Five to Seven

Sessions five through seven used DSH for reinforcement of previous sessions along with Hartland’s ego-strengthening suggestions.  JM was taught to anchor self-hypnotic trance with a personal three-word mantra (“relax, relax, relax”) that allowed rapid self-hypnosis and deepening with finger lift and lowering.  JM reported that she was having hand surgery for carpal tunnel and wanted to know if she could utilize her Glove Anesthesia technique for pre and post-operative pain relief.  JM had had several previous surgeries on this particular hand and was concerned with discomfort.  I assured her that the Glove Anesthesia would be perfect for her to use with the caveat that she let her surgeon know of her use of this hypnotic technique for both the pre and post-operative discomfort.  If there was no contraindication voiced by the surgeon, all would be well.

Session Eight

JM reported that the hand surgery went well, she did not have any migraine headaches, and that the Glove Anesthesia worked well for post-operative pain control.  She reported that her surgeon had no reservations for her utilizing the glove anesthesia technique the she had learned. She reported that she and the surgeon had known each other professionally for some time, and that he respected her knowledge of pain control methods.  I encouraged JM to continue her self-hypnosis each and every day to the point where it is as “easy to enter trance as it is to take a deep breath.”  JM entered trance utilizing the arm drop PHS.  We deepened her trance level with the usual fractionation technique and then proceeded to utilize ideomotor finger signaling to identify any unresolved issues pertaining to her migraine headaches.  JM was asked, “is there any reason you cannot be free of migraine headache?”  JM’s “no” finger responded slowly.  DSH was given to continue daily self-trance, relaxation, and to utilize her techniques as needed.

Results and Followup

            JM continues to utilize self hypnosis on a daily schedule.  She is quite pleased with the outcome of the hypnotic sessions and with her use of self-suggestion.  Prior to treatment with clinical hypnosis interventions, JM had multiple severe and incapacitating migraines that were impacting her usual ADL as well as her work schedule.  This continued for a number of years (>15 yrs.) with little or no relief provided using conventional therapy or medication.  After eight weeks of clinical hypnotic interventions (in 2008), JM denied having any headaches and had already begun talking with her physician about decreasing and perhaps eliminating some of the daily medications.  JM reported being extremely pleased with her results and pleased with the use of self-hypnotic techniques in her life.  She remains migraine-free ten months after her last office visit.  As I am writing these revisions for publication (April 2010), JM reports that since our last visit (December 2008), she has had only one migraine, lasting 4-6 hours.  She reports that currently she only takes a daily multivitamin and Alleve for joint pain.

Discussion

            Migraine headaches are debilitating (Hammond 2007; Turk & Gatchel 2002).  According to Hammond (2007), hypnosis has an impressive track record in pain treatment.  A meta-analytic review (Montgomery, DuHamel, & Redd, 2000) indicated that hypnosis was an efficacious and specific treatment for pain that is superior to pill and psychological placebo.  Hypnosis has been shown in recent studies to decrease intraoperative anesthetic requirements as well as decreasing post-operative narcotic pain relief (Mackey 2010).  JM spent many years enduring the incapacitating symptoms associated with her migraine attacks.  She had endured multiple treatment regimens aimed at symptom relief and had become disillusioned with the current state of medical treatment for individuals with her condition.

It is important to mention that secondary gain issues prevent permanent change from occurring.  Likewise, sometimes secondary gains (as in holding on to symptoms) diminish and symptoms will disappear as there is no longer any need by the patient to hold onto the symptoms.  It is important for a practitioner to identify, early in the therapeutic process, the possibility that a patient has secondary gain issues.  This can be done conveniently by utilizing ideomotor movements (finger signals).  Asking yes-or-no questions concerning needs and desires while the patient is in trance is an efficacious method to uncover any resistance to suggestion (Cheek and LeCron, 1968: Ewin & Eimer, 2006; Mackey 2009).  Finger signaling was utilized early in the therapeutic interactions with JM to identify any possible resistance to hypnotic intervention. Ideomotor finger signaling has been described earlier in this work; however, it is important for those unfamiliar with this type of subconscious review to identify what these movements look like.  It is most important to identify and distinguish between conscious and subconscious ideomotor signals.  Subconscious signaling does not happen immediately after a question.  There is a delay that may be as long as 45-60 seconds before the finger begins to twitch slowly and move up and down.  Sometimes the delay in movement may be as short as 10 seconds, but in any case, there is never an immediate and deliberate movement of the finger.  A finger that is moving smoothly and deliberately is simply the conscious mind answering yes or no (Ewin & Eimer, 2006).

Hypnotic intervention worked well with JM, perhaps in part due to her desire and motivation to rid herself of migraine symptoms.  Because of this, the patient was self-motivated to follow suggestion and persevere with frequent self-hypnotic sessions in addition to the regularly scheduled office visits.  Obviously a single case report is not generalizable to the larger population with migraine symptoms, yet it does imply that perhaps hypnosis and suggestion can play a definite therapeutic role in the complementary treatment of migraine symptoms.  This case study, however, does represent one methodology to assist in the reduction of pain and discomfort for those who suffer from migraine headaches.  It would perhaps be beneficial to follow up reports such as this with a randomized and controlled research design to further investigate the significance of this type of intervention.


References

Abrams, A. (2006). Clinical drug therapy: Rationales for nursing practice. (8th ed.)  Philadelphis: Lippincott.

Andreychuk, T. & Skriver, C. (1975). Hypnosis and biofeedback in the treatment of migraine headache. The International Journal of Clinical and Experimental Hypnosis. 23: 172.

Bassman, S., W. & Wester, W., C. (1997). Hypnosis, headache and pain control: An integrative approach. American Society of Clinical Hypnosis Press

Barabasz, A.(1977). New techniques in behavior therapy and hypnosis. South Orange, New Jersey: Power Publishers.

Barabasz, A., & McGeorge, C. (1978). Biofeedback, mediated biofeedback and hypnosis in peripheral vasodilation training. American Journal of Clinical Hypnosis, 23, 23-37.

Blumenthal, L. (1963). Hypnotherapy of headache. Headache. 2:197.

Brown, D., Scheflin, A. W., & Hammond, D.C. (1998). Memory, trauma, treatment and the law: An essential reference on memory for clinicians, researchers, attorneys, and judges. New York: W.W. Norton & Company.

Cheek, D.B., LeCron, L. M. (1968). Clinical hypnotherapy. New York: Grune & Stratton.

Ewin, D. M., Eimer, B. N. (2006). Ideomotor signals for rapid hypnoanalysis. Springfield Illinois: Charles C. Thomas Publisher.

Graham, G.(1975). Hypnotic treatment for migraine headache. The International Journal of Clinical and Experimental Hypnosis. 23:165.

Hammond, D. C. (2007). Review of the efficacy of clinical hypnosis withheadaches and migraines. The international Journal of Clinical and Experimental hypnosis, 55(2): 207-219.

Mackey, E. F. (2010). Effects of hypnosis as an adjunct to intravenous sedation for third molar extraction: A randomized, blind, controlled study. The Interantional Journal of Clinical and Experimental Hypnosis 58(1): 21-38.

Mackey, E. F. (2009). Age regression: A case study. Annals of the American Psychotherapy Association 12(4) 46-49.

Montgomery, G. H., DuHamel, K. N., & Redd, W. H. (2000). A meta-analysis of hypnotically induced analgesia: How effective is hypnosis? The International Journal of Clinical and Experimental Hypnosis, 48, 138-153.

Olness, K. & Kohen, D.P. (1996). Hypnosis and hypnotherapy with children 3rd ed. New York: The Guilford Press.

Olness, K., MacDonald, J. & Uden, D. (1987). Comparison of self hypnosis and propranolol in the treatment of juvenile classic migraine. Pediatrics. 79, 593-597.

Turk, D., C. & Gatchel, R., J.(2005). Psychological approaches to pain management: A practitioner’s handbook 2cnd ed. New York: The Guilford Press.

 


About the Author 

Mackey_EdwardDr. Ed Mackey received his diploma in Nursing from the Lankenau Hospital School of Nursing in 1983 and his BSN from Eastern University in 1986. He graduated from the Lankenau Hospital School of Nurse Anesthesia in 1988 and has been a practicing CRNA since that time. Dr. Mackey received an M.S. in Nurse Anesthesiology from St. Joseph’s University in Philadelphia Pennsylvania. He received an MSN in Community /Public Health Nursing from West Chester University and received a Ph.D. in Psychology from Northcentral University.

Dr. Mackey is an Approved Consultant in Clinical Hypnosis for the American Society of Clinical Hypnosis (ASCH), is a Diplomate in the American Psychotherapy Association (DAPA), and maintains a long standing private practice in hypnosis/hypnotherapy/psychotherapy in Kennett Square, Pennsylvania. Dr. Mackey is an Assistant Professor in the Department of Nursing at West Chester University of Pennsylvania. He is adjunct faculty at Villanova University’s graduate program in Nurse Anesthesiology and maintains a part time private practice in the administration of office anesthesia.

Dr. Mackey is a member of the American Psychotherapy Association (APA), The Association of Applied Psychophysiology and Biofeedback (AAPB), The American Association of Nurse Anesthetists (AANA), The American Society of Clinical Hypnosis (ASCH) and The Greater Philadelphia Society of Clinical Hypnosis (GPSCH).


The Integration of Classical Music Composition Theory in the Facilitation of Expanded Trust, Appreciation, and Utilization of opposites in Treatment

The Integration of Classical Music Composition Theory in the Facilitation of Expanded Trust, Appreciation, and Utilization of opposites in Treatment

By Bruce Gregory, PhD

Jung’s identification and appreciation of the transcendent function in the integration of the conscious and unconscious minds set the stage for almost a century of exploration and use of unconscious healing resources in a variety of treatment situations, which ultimately incorporated trust and appreciation of the use of opposites.  The integration of principles of classical music composition theory with Mind-Body Hypnotherapy supports the need to use opposites in treatment, and shows new pathways for the application of the implied directive, the equivalence principle set forth by Einstein, and the principle of correspondence used in the set theory of Cantor.  Classical music composition theory is applied primarily through the creative use of principles and processes involving tension and release, as well as the principles and processes of counterpoint.  The application of Mind-Body Hypnotherapy in the treatment of opposites is compared to other therapeutic modalities, principles of duality from oriental philosophy and martial arts.


Build Muscle

by Tammera J. Karr, PhD

One of the most feared events for the elderly is falling and breaking a hip, which leads to a lengthy and, sometimes, fatal stay in a hospital. When I say fatal, I don’t mean because the hospital did something wrong, however, complications outside of their control can occur. Many elderly individuals upon reaching the hospital are deficient in key nutrients such as vitamin D and B12, the lack of which contribute to impaired balance and osteoporosis. Combine those deficiencies with a lack of macronutrients, like protein, and recovery can be problematic.

“You are what you eat.” That is especially true when it comes to how your body manufactures protein for use in muscle health. Research supports the notion that elderly people are often times not consuming adequate protein. According to Nutrition Review, “It is well known that consuming protein stimulates the body’s cells to build muscle that includes our internal organs. Getting older combined with eating less protein rich foods can lead to a decline in the body’s muscle-building efficiency. Maintaining and building muscle is especially important for older individuals. Increased muscle mass can contribute to a healthier weight, better fitness and an improved quality of life. New research in the American Journal of Physiology — Endocrinology and Metabolism explore whether the amount and timing of protein consumption make a difference in the body’s net protein gains.”

(http://nutritionreview.org/2015/02/older-adults-need-to-double-protein-intake-to-prevent-muscle-loss/)

“Current US recommendations for daily dietary protein intake are 0.8 grams/kilogram of body weight (roughly 62 g of protein per day for a 170-pound person). Previous research has shown older adults need a protein intake of at least 0.40 g/kg of body weight at each meal.” (www.medhelp.org/user_journals/show/1412586/-current-dietary-guidelines-on-protein-intake_br)

The research team found, while the distribution of protein across meals did not make a significant impact, the total amount of protein consumed did. The authors wrote, “Whole body net protein balance was greater with protein intake above recommended dietary allowance.”

As is so often the case the RDA is horribly lacking, and insufficient in its recommendations.

 

To Your Good Health and Information.

 First published April 7th, 2015 in BlogEat for Health

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