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Creating Stress Resilience - as Defined by Health Outcomes

Creating Stress Resilience - as Defined by Health Outcomes. N. Lee Smith, MD Clinical Associate Professor of Medicine University of Utah Director, Stress Medicine Clinic and Center for Interdisciplinary Medicine HealthSouth Rehabilitation Hospital.

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Creating Stress Resilience - as Defined by Health Outcomes

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  1. Creating Stress Resilience-as Defined by Health Outcomes N. Lee Smith, MD Clinical Associate Professor of Medicine University of Utah Director, Stress Medicine Clinic and Center for Interdisciplinary Medicine HealthSouth Rehabilitation Hospital

  2. What does stress have to do with medical illness?

  3. The Most Common Medical Problems Involve Central Nervous System Hypersensitivity: • Irritable bowel syndrome • Atypical chest pain (and cardiovascular disease) • Migraine and Tension Headaches • Fibromyalgia & Myofascial Pain Syndromes • Anxiety disorders • Multiple allergies (and auto-immune disorders)

  4. Does stress reduction work? If so, what are the keys to success?

  5. Stress Management Quiz Which one of the following has not yet been shown to have improved outcome by stress management? 1. Myocardial Infarction 2. Rheumatoid arthritis 3. Metastatic breast cancer 4. Hypertension 5. Hip fracture repair 6. Obstetrical delivery 7. Psoriasis

  6. Comparing Stress Reductionand Exercise in CAD Patients 30 25 20 Coronary Events (%) 15 10 5 0 Usual Care Exercise Stress Reduction Intervention Blumenthal JA, et al Arch Int Med 1997;157:2213-2223

  7. Arthritis Outcomes with Self-Management Training • Pain 20% • Self Efficacy • Medical Office Visits 43% • Costs $189 (OA)-$648 (RA) over 4 yrs K. Lorig, Arthritis Rheum (1985) 28:680-5. Design: 400 patients with OA and RA Six 2-hour Sessions °

  8. Medical Utilization with Depression and Anxiety 100 100 100 90 78 80 70 70 60 56 56 Percent Depressed or Anxious 50 42 % Depression 38 40 % Anxiety 30 20 10 0 Smith NL, Am. Psychosomatic Society Annual Meeting 1996 0 to 5 6 to 10 11 to 20 21 to 30 Number of Medical Visits in the Past Year

  9. Information Mindfulness Cognitive VariableOnlyMeditation& Experiential Physical Sx 5% 14% 35% (of 25) Med. Visits 3.9 4.5 5.4 3.8 5.7 1.8 (6 mo.) ( 15%) ( 30%) (68%) Conclusion: To be effective, the interventionmust be experiential CJC Hellman, Behav Med, 1990;16:165-173(p< .001) Behavioral Medicine Interventions: Effects on Medical Symptoms and Costs - High utilizers (>9 visits/yr.) Weekly for 6 weeks

  10. Control and Serotonin (5HT) Levels UCLA Vervet Monkey study • Dominant male 5HT levels = 2X subordinates • Remove the dominant male: • Submissives’ (now in control): 5HT levels rise • Females cozy up: 5HT levels rise • Remove the submissives: • Dominant’s 5HT levels fall -M. McGuire

  11. Creating Stress Resilience • Is stress good or bad? • What makes the difference? • An important key: • How much sense of control do you feel in dealing with it?

  12. Animal Studies:Cancer Cell Rejection Percent immune rejection of the cancer cells -Martin Seligman, U. of Penn

  13. Four Principles of Stress Resilience Clearly Related toImproved Health Outcomes • A sense of personal control • A sense of connectedness • A sense of purpose and meaning • Hope Karren K, Hafen B, Smith NL, Frandsen K: Mind-Body Health… 1996 (Allan & Bacon, Boston) and 2001 (Benj Cummmings, S.F.)

  14. The Paradox of Control • The more you try to take control of the world out there, the more out of control it seems • The more you let go trying to control the external world, and instead, respond in a way that you would deeply admire as wise, the more personal control you feel

  15. The Process of Control 1. Realize I am responsible for a. what I give myself and my energy to (Call it back) b. how I think and thus respond (“I am in charge of me.”)

  16. The A, B, Cs of Feelings A. The situation(as perceived) B. Evaluative thinking (should, forced, threat, worth issues) C. Response: feelings + physiological  behavior

  17. The A, B, Cs of Feelings A. The situation B. Evaluative thinking C. Response: If the response (C) is destructive, then the causative thinking (B) will be found to: 1. be irrational 2. violate one’s deeper values and wisdom

  18. Creating a Different Response A. The situation B. Evaluative thinking (should, forced, threat, worth issues) C. Response: feelings + physiological behavior B’ (new) C’ (new)

  19. The Process of Control 1. Realize I am responsible for how I think and thus respond (“I am in charge of me.”) 2. So, how do I want to be? Disengage from old thinking (Cognitive & relaxation techniques) Values clarification (Meditative and reflective techniques) 3. Visualize being that way

  20. It is as if we have Two Minds Operating mind (thoughts by which to function) Core, wise mind (source of core values and inner wisdom)

  21. lift each other safe, acceptance honest, authentic kind caring A truly great relationship honors needs create hope humor win-win

  22. A Sense of Personal Controlhas much to do with integrity to one’s deepest, wise values

  23. It is as if we have Two Minds Operating mind (thoughts by which to function) The key: How to transform the operating mind to be one with the wise mind Core, wise mind (source of core values and inner wisdom)

  24. High Sense of Personal Responsibility Forgiveness Low = BLAME Low High Negative Emotions (fear, anger, frustration) Positive Emotions (confidence, love, trust) Sense of Personal Control

  25. Forgiveness is taking back control of your life:Being the way you want to be regardless of another’s actions

  26. A Sense of Connectedness: • To one’s deepest self • To other people • To the larger sources of one’s power

  27. Is the way I’m handling this situation: Connecting us more deeply? or Disconnecting us?

  28. A Sense of Purpose and Meaning • A sense of mission: altruism • This situation has purpose • Loving growth • Understanding crisis as opportunity

  29. Creating Hope • Visualizing(experiencing) one’s self handling the situation well, in accord with wisdom and deepest values

  30. Dealing with Times of Chaos What gives a sense of control? • Hope • Loving support

  31. Stress Resilience can be learned It takes practicing experientially to do so

  32. How to Create a Sense of Personal Control and Hope • Conscious awareness“I can respond as I choose.” • Relaxation skills:To let go and get focused • Clarify deep values “How do I want to be?” • Visualizing (experiencing)responding the new way

  33. Four Mental-Spiritual Principles Highly Associated with Good Health Outcomes

  34. SummaryResilience and Healing has a great deal to do with: • Empowerment & Forgiveness (Personal control) • Caring Love: giving and receiving (Connectedness) • Transforming and deepening life : -Understanding the value of its events(Purpose) • Fostering Hope

  35. Summary • Mental stress, depression and anxiety are highly associated with the most common medical problem • Treating the stress issues well (both medically and non-pharmacologically) can significantly improve medical outcomes and ability to function • The principles of stress resilience and techniques for implementing them have been outlined

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