Quality Stress Management Course

8 Minute Meditation for Stress Relief

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

8 Minute Meditation for Stress Relief Summary


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Contents: 2 Ebooks, Guided Meditation Audio
Author: Victor Davich
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Stress Management Training

Strategies to help people cope with stress are many and varied. Some may be as simple as the provision of reassuring information. Others require a more complex technology. This chapter will focus specifically on strategies that fall within the rubric of stress management training. The approach is based on the model of stress described above and aims to Many stress management programs simply teach relaxation techniques to minimize the high levels of arousal associated with stress. More complex interventions try to change cognitive (and therefore emotional) reactions to environmental triggers. Few address the factors that initiate the stress response. Given the idiosyncratic nature of both the stressors individuals may experience and the complexity of changing their cognitive response to them, interventions that address these factors are often led by specialists in stress management, and may best be targeted at individuals who are experiencing significant levels of stress. By contrast,...

The Role of Cardiac Rehabilitation Psychological Support and Stress Management

Psychosocial factors play an important role in the prevalence and in the progression of coronary artery disease. This has consequences for the provision of psychosocial support within the framework of a CR service. The psychological expertise within the CR team should advise the employer on means of limiting a stressful work environment in patients where mental stress or strain at the workplace has been reported. Patients may be helped by participating in stress management classes or in special cases through individual counseling by a psychologist. Overprotection by family and friends and the attitude of work colleagues and supervisors may extend sickness absence. Here clear and timely information from the CR team is invaluable Anxiety and depression should be diagnosed early post-MI and treated if indicated with pharmacotherapy. Repeated mental reinforcement within the CR program may help the patient to regain self-confidence and trust in the ability to face work demands.

Relaxation and Stress Management

Techniques that may be used include relaxation training, breathing re-training, biofeedback, yoga, meditation, rapid relaxation and the identification (using questionnaires) of our own behavior and attitudes that lead to anger and stress. Each week one of the patients is asked to recall a recent event that had stressed them or made them very angry and the group is shown stress management techniques to avoid this. Patients are taught a rapid relaxation and distraction technique that they can

The Impact of Stress Management

In terms of summarizing a large body of evidence, a recent Cochrane review3 reported that stress management procedures are effective in reducing distress. Other goals may be to improve the rehabilitation process, improve health, and or prevent disease progression. Unfortunately, from a scientific perspective, many stress management interventions are combined with other interventions such as exercise programs, making it difficult to isolate a specific therapeutic effect of the stress management. Nevertheless, the relatively small number of studies that have used stress management in isolation suggest a beneficial impact on these other goals. For instance, a meta-analysis of 27 trials of relaxation therapy in the rehabilitation of cardiac patients found that intensive supervised relaxation practice contributed to many secondary prevention outcomes - psychological, vocational, physiological, and clinical.4

Stress Management

Stress management training aims to change environmental triggers to the stress response and or change inappropriate behavioral, physiological, or cognitive responses that occur in response to this event. High levels of muscular tension can be reduced through relaxation techniques triggers can be identified and modified using problemsolving strategies cognitive distortions can be identified and changed through cognitive techniques such as cognitive restructuring and stressed behaviors can be changed through consideration and rehearsal of alternative behavioral responses. Many stress management programs teach simple relaxation techniques to minimize high levels of arousal. More complex interventions try to change cognitive (and therefore emotional) reactions to environmental triggers. A few address factors that initiate the stress response. Given the idiosyncratic nature of both the stressors that individuals experience and the complexity of changing their cognitive response, such...

The Evidence Hierarchy the Randomized Controlled Trial and the Systematic Review

Nevertheless, one RCT is rarely enough evidence on its own. A single study may well not be large enough to have the statistical power to detect the effect of the treatment being tested, particularly if that effect is fairly small - as most modern day therapies are. A single study may not be representative of the range of real world practice. For example, returning to the example RCT, it may be that your practice includes patients with NYHA class IV heart failure. It may be that your CR practice only includes exercise training while the RCT is based on exercise training plus stress management training and education. By looking for all RCTs that have investigated the question of the impact of CR on patients with HF, it is more likely that this overall body of evidence will reflect the range of real world practice than will one RCT alone.

Newer Concepts Regarding Physiologic Benefits of Exercise Training

A longstanding and attractive hypothesis is the concept that exercise training can reverse or retard the progression of atherosclerosis. The observation that regression of atherosclerosis occurred in animal studies dating back to the 1950s continues to stimulate interest in the effects of exercise on the coronary vasculature in humans. While this idea was largely rejected during the 1970s and 1980s, several notable studies were performed during the 1990s indicating that exercise training, when combined with multidisciplinary risk management, can improve myocardial perfusion.33-35 This has been demonstrated indirectly using nuclear imaging33 and directly by angiography.34,35 Because most of these studies involved multidisciplinary risk reduction (e.g. diet, smoking cessation, stress management, and pharmacologic management of risk factors, including statin therapy) in addition to exercise training, it is not possible to determine the independent effects of exercise training.

Scientific Foundations

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

Relationships Between Biological and Clinical Characteristics

Bipolar and nonbipolar depressions may have similar clinical characteristics, but with different biological mechanisms. For example, impairments of fine motor function can be identical in bipolar and unipolar depressions, but in bipolar depression they are more closely related to noradrenergic function and to severity of the depression (Swann et al. 1999). Similarly, treatment response (Maas et al. 1984) and sensitivity to stressful events (Swann et al. 1990) are more strongly related to norepinephrine in bipolar than in unipolar depressions. In terms of Figure 2-1, these results suggest that clinically similar syndromes have different biological correlates in bipolar and unipolar disorders.

Management of Psychosocial Risk Factors

Exercise training is of particular interest because of the general beneficial effect of exercise and physical activity on several cardiovascular parameters. Evidence suggests that exercise may also modify psychosocial risk factors, including depression. Cross-sectional studies of patients as well as healthy men and women have demonstrated lower depression scores among those who are most active. The ability of exercise to reduce depression also has been demonstrated in randomized controlled trials, although many of these studies have had methodological limitations.54 In a randomized controlled trial of 134 US patients (92 male and 42 female aged 40-84 years) with stable ischemic heart disease (IHD) and exercise-induced myocardial ischemia, exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk, such as left ventricular ejection fraction and wall motion abnormalities, flow-mediated dilation, and cardiac autonomic control more than...

Chronic fatigue syndrome and stress

Life events checklist (Lewis and Wessely 1992). Prospective studies have found that the experience of stressful life events is more strongly associated with the onset of psychiatric disorder and the severity of fatigue, rather than CF or CFS (Bruce-Jones et al. 1994 Chalder et al. in submission). Thus, patients' perceptions of stressful events rather than life events

Behavioral Interventions

The goal of behavioral change is to help the individual respond to any stress triggers in ways that maximize their effectiveness in dealing with the trigger, and causes them minimal stress. Some behaviors can be relatively simple. Behaviors that reduce the stress of driving may involve, for example, driving within the speed limits, putting the handbrake on when stopped at traffic lights and taking time to relax, not cutting people up, and so on. Others may take practice - a person who becomes excessively angry, for example, may role play assertive responses within therapy sessions to prepare them for doing the same in real life. Still others have to be thought through at the time of the stress. Here, the goal of stress management training may be to teach the individual to plan their response to any potential stressor to be one that minimizes their personal stress. A simple rule of thumb that can be useful here is to encourage individuals to stop and plan what they are going to do -...

Evidence for Altered Psychological State

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

Studies of Neurotransmitter Function

Regardless of differences in amounts of NE and its metabolites, patients with bipolar disorder appear to have increased reactivity to NE. More so in bipolar than in unipolar depressions, noradrenergic function is more strongly related to mood and psychomotor impairment (Swann et al. 1999), treatment response (Maas et al. 1984), and relationship to stressful events (Swann et al. 1990). Subjects with bipolar disorder have increased sensitivity to subjective effects of stimulants (Anand et al. 2000). Pharmacologically increased NE precipitates mania in subjects with bipolar disorder (Price et al. 1984) and may selectively improve bipolar depression (Osman et al. 1989). Subjects with bipolar disorder

The influence of distress on symptoms

Anxiety can also make us more alert to other physical problems. If a new symptom is detected, it is more likely to be interpreted as a sign of an illness than if it was thought to be a normal response to a stressful situation (Moss-Morris and Petrie 1999). Distress and bad moods also influence self-reports of health and symptoms. From studies where mood has been manipulated in a laboratory situation, we know that people in a positive mood rate themselves as healthier and report fewer symptoms. However, people in negative moods report more symptoms, are more pessimistic that any actions they take would relieve their symptoms, and perceive themselves as more vulnerable to future illness (Salovey et al. 1991). Similar findings are made if people undergo induction techniques to make them more self-focussed. Increased self-focus leads to an increase in symptom reports, suggesting that negative mood may operate through the process of heightened awareness of the self (Ingram 1990).

Defining Mental Disorders

As you probably already realize from your own experience, it is often difficult to draw a clear line between mental and physical disorders. Sometimes, when you become physically ill, it is obvious that your stress level or mental state has contributed to your illness. On the other hand, when you're emotionally or psychologically distressed, your physical condition (perhaps physical pain or illness) frequently and sometimes profoundly contributes to your disturbed emotional state and thinking processes (Witvliet, Ludwig, & Vander Laan, 2001). The difficulty distinguishing between mental and physical problems is acknowledged by DSM's authors

Preventing Reinfarction

The largest study involving the use of stress management in post-MI patients7 targeted type A men (i.e. those who scored highly on measures such as time urgency, competitiveness, hostility, and easily aroused anger a form of self-stress ) who had experienced a recent MI. Over a 4-year intervention, participants in the type A management program were at half the risk for further infarction than those in a similarly long, but traditionally focused, rehabilitation program, with total infarction rates over the 4.5-year study of 6 and 12 in the groups, respectively. Other studies have shown positive gains following shorter and more general stress management interventions. Blumenthal and colleagues,8 for example, assigned patients to a 4-month program of exercise or stress management training or usual treatment control. Participants in the stress management group were significantly less likely to have a cardiac event over the follow-up period than participants in either other condition....

Background Gender Differences in Cardiac Rehabilitation

Stress management, can reduce further heart problems. It is known that psychosocial intervention is beneficial in lowering blood pressure, improving lipid levels, and reducing negative stress and symptoms of depression. However, psychosocial intervention in patients with MI showed no objective evidence of improvement in anxiety, depression, morbidity or mortality in a British study.14 This underlines the need for further studies in this field and consequently we have started a heart rehabilitation program with stress management especially designed for women.

Modulation of Visceral Pain by Stress

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

Sex Differences in Brain Functional Magnetic Resonance Imaging Response to Stress

The term stress may be defined as a process involving perception, interpretation, response, and adaptation to harmful, threatening, or challenging events (Lazarus & Folkman, 1984). This definition allows for the separate consideration of (1) events that cause stress (internal or external stressful life events) (2) cognitive and affective processes evaluating the event and available coping resources (knowledge, attitudes beliefs, personality traits, cognitive appraisal, and emotional processing) (3) physiological and neural adaptation to regain homeostasis (in the case of acute stress) or to achieve physiological stability through the process of change (i.e., allostasis, in the case of chronic stress) and (4) behavioral and cognitive responses (coping). These components of stress are influenced by individual differences, resulting from a combination of genetic and environmental factors that play a significant role in determining the vulnerabilities and risk for development of various...

Case Study 2 Client X Adidas Employee

Mended by the appropriate national international cardiac rehabilitation organizations (i.e. the European Society of Cardiology Guidelines on Cardiac Rehabilitation and Secondary Prevention), notably exercise conditioning, nutritional dietary counseling, cardiac risk factor management, smoking cessation relapse prevention, stress management, vocational, educational and psychosocial aspects, quality of life measurements specific to cardiac populations, and evaluation outcome measures for the program. In addition, it is highly desirable that a behavioral counseling approach is taken when delivering cardiac rehabilitation wellness preventive services to employees, promoting a client-centered approach towards lifestyle change and cardiovascular risk reduction management.

The Contribution of Parenting

Stressful life conditions are linked to adverse child outcomes by diminishing positive interactions and increasing parental coercive behavior (Patterson, 1983 Patterson, DeBaryshe, & Ramsey, 1989). Two orthogonal dimensions of parenting (positive and negative) are considered because these dimensions have been found to differentially predict child behavior. For example, harsh parenting predicted child aggression, but not social competence among dyads exposed to inner-city violence in New York City (Krenichyn, Saegert, & Evans, 2001). Based on normative parenting literature, we anticipated that positive parenting (i.e., noncontrolling, involved, warm mother-child interactions) contributes to fewer behavior problems, while negative parenting (i.e., controlling, uninvolved, angry mother-child interactions) contributes to more behavior problems. In regard to the association between exposure to community violence and parenting, we expected that mothers exposed to low levels of community...

Test or Performance Anxiety

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

Brain Responses To Emotional Stress Preliminary Evidence Of Sex Differences

In a series of studies, my colleagues and I have been examining the effects of emotional stress on drug craving and relapse in individuals who abuse substances. Emotional stress, or distress, commonly occurs in situations that are challenging or threatening, and it influences adaptive processes that require self-regulation or coping to regain control and attain desired goals (Sinha, 2001). Our initial findings with substance-abusing individuals and healthy volunteers has shown that emotional stress is associated with the subjective experience of multiple negative emotions, such as the experience of anger, sadness, and fear (Sinha, 2001 Sinha, Catapano, & O'Malley, 1999). As difficulties in managing stressful life events and regulation of the emotional distress state are common in a variety of psychiatric illnesses, including addic Participants in this initial preliminary study were 7 men and 1 woman with a mean age of 33 years (SD 5.7) and educational level of 13.3 years (SD 2.3)....

Salivary Cortisol Secretion in Response to Stress

To assess HPA axis functioning in response to stress, all daughters undergo a 15-minute stress session. They complete a 3-minute serial subtraction task followed by a 12-minute social competence interview, developed to induce emotional arousal by discussing stressful life situations. Four saliva samples are collected over the course of 50 minutes one sample immediately before task instructions, and three samples at 15, 30, and 45 minutes after the onset of the stressor. Following the laboratory stressor (i.e., during collection of the final two samples), participants watch a neutral videotape. As can be seen in Figure 17.4, the high-risk daughters exhibited both an elevated immediate response to the stressor and a slowed cortisol recovery. These data indicate that stress activates the HPA axis in individuals at heightened risk for depression to a greater extent than is the case for nonvulnerable individuals, and suggest a mechanism by which stress may play a role in the onset of...

Directions For Genetic Research

To expand on this theme, one of the most consistently observed associations between early psychosocial factors and the development of mental disorders in adults has been the correlation between childhood parental loss and major depression. To our knowledge, the only study of this relationship that has used a genetically informative sample is that of Kendler et al. (1992), who extensively studied a large cohort of female twins (N 1,030), 57 of whom were monozygotic. After factoring out genetic contributions and using multiple regression and relative risk analyses, this group found evidence for a modest effect of either parental separation or death or both on the risk of major depression, generalized anxiety disorder, and panic disorder or phobia in the offspring. However, the percentage of the total variance in liability due to nonge-netic factors operating earlier in childhood was small, ranging from 1.6 to 4.9 . For major depression in these adults, the genetic contribution was...

The Swiss Heart Foundation

Physiotherapists or PE (physical education) teachers, they meet for an exercise program of 60-90 minutes duration once to three times a week. In addition, most heart groups regularly offer nutritional, smoking cessation, and stress management consulting. administration. In addition, brochures with easily understandable information on cardiovascular disease, rehabilitation, and secondary prevention are offered to the groups and their members. Furthermore, an educational manual covering healthy nutrition, smoking cessation, and stress management is in the pipeline.

Approach To Diseases Of The Breast Palpable Breast Mass

Laboratory testing is usually unnecessary in the evaluation of mastalgia, although a pregnancy test should be performed in reproductive-age women. Hormonal contraceptives or hormone replacement therapy may be causes of breast pain and consideration should be given to discontinuation or reduction of estrogen dosages. An appropriately fitted supportive bra and lifestyle changes, such as tobacco cessation, caffeine elimination, and stress reduction techniques, are often successful in alleviating symptoms. Evening primrose oil is available over the counter, is well tolerated, and often provides relief. For women with unrelenting pain in spite of the above modifications, danazol, an antigonadotropin, is Food and Drug Administration (FDA) approved for the treatment of breast pain, but is relatively expensive and has numerous side effects (hair loss, acne, weight gain, irregular menses).

Suggested Readings And Resources

The helping interview (3rd ed.). Boston Houghton Mifflin Co. This classic text includes information in Chapter 1 on physical conditions such as the room, and in Chapter 4 on recording interviews. Davis, M., McKay, M., & Eshelman, E. R. (2000). The relaxation and stress reduction workbook. Oakland, CA New Harbinger. This practical and clearly written workbook is primarily for use with clients. However, because providing therapy is stressful, it makes sense for clinicians to apply the strategies outlined in this book to themselves. Diller, J. V., Murphy, E., & Martinez, J. (1998). Cultural diversity A primer for the human services. London International Thomson Publishing. This book offers both clinical and theoretical material designed to help professionals provide cross-cultural human services effectively. It includes interviews with professionals from four ethnic backgrounds Latino Latina, Native American, African American, and Asian American. Kabat-Zinn, J....

Cognitive and Biological Functioning in Children at Risk for Depression

In attempting to identify potential risk factors and mechanisms of risk for depression, it is helpful to turn to the formulation that what characterizes depressed individuals is not so much an abnormal initial response to a stressor, such as a stressful life event, but rather the maintenance of the ensuing affective state. Thus it may be that prolonged or incomplete recovery from affective states, and accompanying cognitive, physiological, and neural changes following exposure to a stressor, are important risk factors for

Emotion Regulation Stress Reactivity And Risk For Depression

Indeed, developing literatures now highlight the importance of biological aspects of emotion regulation and responsivity to emotional stimuli (Davidson, Pizzagalli, & Nitschke, 2002 Rottenberg, Wilhelm, Gross, & Gotlib, 2002). It is clear, therefore, that the study of cognitive aspects of depression must be expanded by adopting a broader, more integra-tive perspective on the processing of emotional stimuli by depressed individuIn this context, recent research attempting to understand the development of negative outcomes in depression has focused on the constructs of stress exposure stress reactivity and recovery and, in particular, emotion regulation and other self-regulatory processes that are engaged in response to stress. Overall, three factors are of particular importance in understanding the heightened vulnerability of children of depressed parents (1) the amount of stress present in the children's environment (2) the perception and evaluation of this...

Psychological and Behavioral Support

The concept of stress and of stress management procedures suited to a cardiac setting is described. This is coupled with a general chapter on the educational role intrinsic in good care for cardiac patients. It is a reminder of the need to see the busy cardiac setting from the perspective of the patient and family members and to be ever mindful that what is a daily job for professionals is a unique, almost always anxiety-provoking and even possibly a very frightening experience for the patient and family.

The Normal Adult Brain

During aging, the brain may be compromised more frequently than in adulthood by external abnormal conditions such as arterial hypoxemia, arterial hypoglycemia and arterial hypotension. These additional stressful events may be assumed to aggravate the changes normally occurring in cerebral oxidative energy metabolism and related metabolism. In profound arterial hypoxemia of short duration only, changes in cerebral glucose metabolism were more severe in aged than in adult animals pointing to insufficient compensation mechanisms during aging (Degrell et al 1983) and to increased vulnerability to anoxia. Recovery of the energy pool in the cerebral cortex after arterial hypoglycemia was found to be more markedly compromised in aged than in adult animals, as was the restoration of the cerebral

Modulation of Brain Responses by Pharmacological Treatments

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

Effects Of Stress On Visceral Pain

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

The Effect of Physical Illnesses on Fitness for Interview

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

Central nervous system findings

The CNS hypothesis of CFS suggests that the symptoms of the illness are caused by a dysregulated neuroendocrine system (Demitrack 1993 Demitrack 1996 Goldstein 1993 Jefferies 1994). Dysregulation is thought to occur through a range of stressful events such as viruses, emotional stress, sleep disruption or overwork, which serve to disrupt the integrity of the hypothalamic-pituitary-adrenal (HPA) axis leading to a glucocorticoid deficiency such as decreased levels of cortisol in the body.

Who Should Be Referred

Numerous studies consistently show that psychological and psychosocial factors contribute to increased risk for CHD. A cluster of negative emotions are related to increased risk, such as depression, anxiety, hostility, type D personality. Among psychosocial risk factors are low socioeconomic status (SES) and social isolation. These have been described in detail in Chapter 30. When CHD has manifested itself, the risk factor pattern is more complex, and findings are less consistent. However, the overall conclusions from studies point to hostility, depression, low SES, and social isolation contributing to increased risk for recurrence. Depression in particular has received considerable attention in recent studies.15 These issues are discussed in other chapters, particularly depression (Chapter 32) and stress management (Chapter 34). Research has shown that such psychological risks are more prevalent among women. Since they are also generally older, the presence of social isolation and...

Overview of the Chapter

Cardiac rehabilitation can be defined as the restoration of physical, psychological, and social functions after a cardiac event. The level of function may not be the same as before the event however, optimal capacity and quality of life should be the goal. Secondary prevention can be defined as the development and practice of long-term strategies aiming at minimizing symptoms, preventing recurrence, and hopefully compressing morbidity and prolonging life. Such strategies entail healthy lifestyle, behavioral and emotional coping skills, stress management, problem solving, and adherence to medication. The involvement of spouse and family members in the rehabilitation has the potential of facilitating the process and improving the outcome.

Information Processing In Depression

One of the major approaches over the past two decades to understanding the etiology of MDD, the functioning of depressed individuals, and vulnerability to this disorder is information-processing theory, which is driven in large part by cognitive models of depression. In general, these models emphasize the importance of cognitive constructs, such as schemas, in placing individuals at elevated risk for experiencing episodes of depression and in hindering the recovery process (Beck, 1967 Bower, 1981 Teasdale, 1988). Thus cognitive theories posit that vulnerable and depressed individuals selectively attend to negative stimuli, filter out positive stimuli, and perceive negative or neutral information as being more negative than is actually the case. Moreover, cognitive theories posit further that because of these negative schemas, depressed individuals are characterized by a negative bias in recall, demonstrating better recall for negative than for neutral or positive material. Negative...

CR Maintenance Phase Difficulties

Cardiac rehabilitation, a comprehensive secondary prevention program, is considered to be the appropriate intervention to promote the adoption of a healthy lifestyle, stress management, and risk factor control in CAD patients.5 Today's challenge is to promote a comprehensive long-lasting program, including exercise, education, and secondary prevention interventions, that is affordable and likely to be maintained in the long run.

How Effective Is CR

Although the question how effective is my therapy appears a simple one, for CR a careful framing of the question is required in order to provide a meaningful answer. In contrast to taking a drug, CR is a complex intervention - one made up of various interconnecting parts. 11 CR is complex in a number ways. First, it is a multi-faceted intervention that can consist of exercise training, psychological therapy (e.g. stress management), education, and other interventions (e.g. occupational counseling) and is usually delivered by a multidisciplinary team. It can be delivered in a variety of different settings (hospital, community center, or patient's own home) and at different points in the disease continuum (phase I to IV programs). Finally, CR is often targeted at to a population of patients that include a variety of cardiac diagnoses, usually post acute myocardial infarction, post coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) and,...

What Is Stress

Early models of stress considered it to arise from our environment, and to impact on us all equally. Holmes and Rahe1 established a hierarchy of severity for various stressors. They also attempted to provide a link between stress and health, suggesting that the more stressful life events an individual experiences, the more their risk of ill-health. Unfortunately, this hypothesis was rarely substantiated. What has emerged from subsequent research is that the impact of potentially stressful events is mediated by our psychological responses to those events. The meaning attributed to events, and the coping responses we use, profoundly influence our emotional and behavioral responses to them. Accordingly, more recent models of stress consider stress to have a number of components a cognitive response ( I am worried I won't cope with this problem ), a physiological component usually involving increased autonomic arousal, a behavioral element involving more or less useful coping responses,...

Reducing Symptoms

Angina may be triggered by emotional as well as physical stresses. Accordingly, several studies have explored the potential benefits of stress management procedures in people with angina. One of the first studies5 found that patients who participated in a stress management program reported reductions in the frequency of angina symptoms, were less reliant on medication, and tolerated higher levels of exercise on a treadmill than those in a usual treatment control group. A larger study, involving a very large sample,6 compared a less intensive intervention involving a stress management program delivered in booklet form combined with three group meetings. At 6-month follow-up, compared to a no treatment control group, participants reported a significant reduction in stress-, but not exercise-related, angina.

Facilitating Action

Having identified what they want to change, some people may remain unsure of how to achieve their goals. Accordingly, the final stage of this element of stress management is to plan ways of achieving the identified goals. Stress may have multiple sources, and some areas of stress may be easier to change than others. It can be helpful to work towards relatively easy goals at the beginning of any attempt at change, before working towards more serious or difficult to change goals as the individual gains skills or confidence in their ability to change.13


A number of practical, professional, and ethical factors need to be considered by clinical interviewers. The more practical factors include the room, seating arrangements, note taking, and video- and audiotaping. Professional and ethical issues include interviewer self-presentation, time boundary maintenance, confidentiality, informed consent, documentation, and interviewer stress management. These issues are basic and foundational they support the interviewing activity and without them, the entire interviewing structure may suffer or collapse. Clinical interviewing is a very stressful activity, both for beginners and experienced clinicians. Consequently, stress management is a professional issue for most interviewers. Interviewers who are having adverse reactions to stress should seek methods for coping with stress more effectively. Suggested readings at the end of this chapter provide useful information regarding stress management for clinical interviewers.


Stomach cancers), or X-linked adrenoleukodystrophy, a genetic disorder with adrenal and neurologic manifestations. Patients with AIDS often develop adrenal involvement as a result of infection with cytomegalovirus (CMV) or Mycobacterium avium-intracellulare. In primary adrenal insufficiency, the glands themselves are destroyed so that the patient becomes deficient in Cortisol and aldosterone. Primary adrenal insufficiency is a relatively uncommon disease seen in clinical practice. A high level of suspicion, particularly in individuals who have suggestive signs or symptoms, or who are susceptible by virtue of associated autoimmune disorders or malignancies must be maintained. The nonspecific symptoms might be otherwise missed for many years until a stressful event leads to crisis and death.

Future Directions

Studies have provided evidence that stressful life events predict bipolar episode onset (e.g., Amberlas 1979 Bebbington et al. 1993 Dunner et al. 1979). Additionally, Mortensen et al. (2003) recently reported an association between parental loss during childhood and bipolar disorder. Furthermore, evidence is also mounting to suggest that events not considered particularly stressful, and even positive events, may play a unique role in bipolar disorder. For example, Malkhoff-Schwartz et al. (1998) found an association between events that disrupted social rhythms (e.g., sleeping, eating) and onset of manic episodes, and Johnson et al. (2000) provided evidence suggesting that life events involving goal-attainment show a specific relationship to manic symptomatology. Despite these findings, and despite the fact that such geneenvironment models are beginning to be successfully applied to unipolar depression (e.g., Caspi et al. 2003), very few studies have incorporated both environmental and...

Literature Review

Younger age, a greater degree of sadness, an inability to handle stress, and a perception of general poorer health status were significantly associated with major verbal aggression. Ethnicity, sadness, and drinking were associated with physical aggression. The conclusion was that there was a low but important annual prevalence of intimate partner violence against female members of a managed care organization. The authors recommended the development of appropriate screening protocols and interventions in this population.

Clinical Features

Cortisol levels show a diurnal variation. Cortisol levels are high in the morning and low as the day progresses, and levels should be elevated in stressful situations such as acute medical illness, surgery, or trauma. A morning plasma Cortisol level 20 jigAlL usually is interpreted as evidence of intact adrenal function. The ACTH stimulation test is used to confirm primary adrenal insufficiency. Synthetic ACTH (cosyntropin) 250 ig is administered intravenously, and serum Cortisol levels are measured at baseline and then at 30- and 60-minute intervals. An increase in the Cortisol level of 7 (Xg dL or a maximal stimulated level 18 ig dL is considered normal and indicates intact adrenal function. If cosyntropin stimulation testing indicates probable adrenal insufficiency, ACTH levels can then be measured to distinguish between primary (high ACTH) and secondary (low ACTH) adrenal failure. The insulin-glucose tolerance test is the gold standard for testing the entire hypothalamic-pituitary...

Stress and Fatigue

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


For a minority it may be recommended to have access to centers with a more specific experience in dealing with coronary patients and where patients may experience a sense of comfort and safety. In referring the patient to the family doctor and or other health program, providers' relevant data must be available (Table 57-2). These may include data regarding exercise capacity, the outcome of the physical training program including specific performance data, results of risk factor intervention such as dietary counseling, smoking cessation, stress management, and promotion of an active lifestyle.

Telephone Systems

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

Emotion Regulation

The results indicated that ability to up-regulate and down-regulate emotion expression independently predicted the magnitude of the stress reduction at the 1Vi year postattack measurement (Bonnano et al., 2004). These findings are consistent with previous research linking both the ability to diminish and enhance emotional responses to subjective well-being and stress adaptation (Diener, 1984 Nolen-Hoeksema & Morrow, 1991).

Depressed Adults

The major cognitive and biological theories of depression implicate stress, often in the form of stressful life events, in the onset of this disorder. In a diathesis-stress formulation, for example, Beck (1967) postulated that in individuals who are vulnerable to depression, negative cognitive schemas are activated by personally relevant stressors from a more biological perspective, Post (1992) presented a kindling formulation of the relation between stress and depression, arguing that less stress is required to precipitate each successive episode of depression (see also Kendler, Kessler, Neale, Heath, & Eaves, 1993 Young & Nolen-Hoeksema, 2001). Given this emphasis on the association between stress and depression, it is not surprising that the potential role of cortisol irregularity in adult depression has been the focus of research for over four decades (Michael & Gibbons, 1963). Dinan (1996) has hypothesized that stressful life events lead to the production of elevated levels of...

Diet Allergies

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

Stress Soothers

Stress Soothers

Free Your Mind And Achieve Peace. Discover How To Live In Peace And Harmony In A World Full Of Uncertainty And Dramatically Improve Your Quality Of Life Today. Finally You Can Fully Equip Yourself With These “Must Have” Tools For Achieving Peace And Calmness And Live A Life Of Comfort That You Deserve.

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