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PAIN MANAGEMENT GROUP. PROGRAM DESCRIPTION. The objective of this pain management program is to help you understand what chronic pain is, why certain treatments have been prescribed, and help you explore/develop “new” skills for coping with pain so you can enjoy a fuller life. .

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PAIN

MANAGEMENT

GROUP


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PROGRAM DESCRIPTION

  • The objective of this pain management program is to help you understand what chronic pain is, why certain treatments have been prescribed, and help you explore/develop “new” skills for coping with pain so you can enjoy a fuller life.


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Goals Of The Program

1. Understand the pain process

2. Recognize what factors increase or decrease pain

3. Understand proper use of medication and their side effects

4. Enhancement of physical functioning

5. Learn how to improve your sleep, mood and relationships

6. Reduction of pain intensity


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Theory of Pain

  • What is pain?

  • it’s a symptom

  • it’s a complex process that involves biological, psychological, behavioral, cognitive, spiritual and cultural issues.

  • the perception of pain can be magnified, colored, and reinterpreted by people’s experiences and expectations.


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Acute Vs Chronic Pain

Acute Pain

  • has an identifiable source, new damage or injury

  • it is time-limited

  • improves with rest and time

  • use of narcotics is normal

    Chronic Pain

  • unrelieved pain and the symptom itself becomes a disease

  • it lasts longer than 3 months

  • activity is necessary for recovery

  • control of medication, to prevent overuse is a must


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How To Take Control Of Your Pain

  • Acknowledge that you are in pain

  • Feeling sad, anxious, angry, & depressed is normal

  • Recognize that you do have choices

  • Determine exactly what is going on, communicate effectively about your pain

  • Set realistic desirable goals

  • Recognize that you can learn to distract yourself consciously from pain


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The Process Involved In Acute And Chronic Pain

The role of the Peripheral Nerves in pain

  • Pain sensory nerves serve as a warning system responding to damaging extreme, trauma, or chemical messengers that are released during inflammation.

  • Sensory nerves bring information about sensory sensations to the spinal cord

  • Sensory nerves hand over these messages to other nerve cells in the spinal cord where the message may be added to other sensory messages received, dampened down, or carried all the way to the brain.

  • Different sensory fibers carry pain sensation at different speed, as a result of that pain is experienced differently


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The Spinal Cord’s Role In Pain

  • Once a pain message makes it to the spinal cord as an electrical impulse, there is a “gate” which determines whether the message will be send, changed or go through. Known as

  • The Gate Control Theory helps explain how you may not notice how much you are really hurting when you are distracted by something else, but are definitely aware of your pain when you are alone, or not distracted by another activity at the time.


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  • Pathways from the brain down through the spinal cord, influence how pain is interpreted.

  • Pain from the sight of injury, travels to the brain with great speed; this is then interpreted by the brain which makes you aware of your pain and discomfort. At the same time the messages that go to your brain are also influenced by messages coming down from your brain.


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What Happens In Chronic Pain influence how pain is interpreted.

1. This involves processes that take place in the peripheraltissues, such as muscles spasm, nerve irritation, inflammation, and in the nervous system.

2. In chronic pain what appears to have happened is that during regeneration of a nerve that has been injured, spontaneous pain messages will be sent to the spinal cord; this “injured nerve” then fails in conducting its normal checks and balances of “normal pain” nerves, and continues to fire even though no injury is occurring.


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3. influence how pain is interpreted. This results in the spinal cord being bombarded by persistent intense levels of pain signals, which results to changes in various areas of the spinal cord. Thus, these areas that are responsible for regulating pain in the spinal cord, eventually lose their ability to respond to the normal checks and balances which serves to modulate or dampen pain, and act independently to perpetuate the pain signal


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Factors Influencing Pain influence how pain is interpreted.

  • Physical factors

    • Drugs

    • Stimulation; reduced muscle tension or arousal

    • surgery

  • Emotional factors

    • Relaxation and stress reduction

    • Positive outlook and pursuing activities of interest

    • Emotional stability

  • Mental Factors

    • Positive attitude

    • Feeling of control

    • Ability to redirect attention


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The Role of The Brain In Pain influence how pain is interpreted.

  • The brain responds to the strength, repetitiveness and duration of the pain message, whether it comes from normal or abnormal pain nerves.

  • The brain can change the pain message by firing impulses that make their way through the pain inhibitory system or through the release of endorphins and other “morphine-like” substances.


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  • The brain gives meaning to the pain message, through connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experience

  • Certain conditions that affect optimum brain functioning are:

    • Insomnia

    • Depression/Anxiety

    • Use of narcotics/sedatives/alcohol


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Treating Abnormal Nerve Activity connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experience

  • Various medications may be used to change abnormal pain nerve activity i.e. TCA’s, Mexiletine, Novocain, Baclofen, Dilantin, Clonopin, etc. Nerve blocks with Novocain-like substances and steroids may be prescribed to alter the firing of abnormal nerves

  • Not all pain messages are paid attention to , there is competition among the messages coming into the spinal cord

  • Rubbing, applying pressure, or changing stimulation to a painful area can be helpful in alleviating pain from time to time.


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  • Therefore, it is important to: connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experience

    • listen to your body

    • pace yourself

    • set realistic goals

    • use your body to change your mind/use your mind to change your body.


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Treatments for Chronic Pain connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experience

  • Medications

  • Relaxation Training

  • Exercise

  • Stress management/problem solving

  • Acupressure

  • Acupuncture

  • Massage


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GSR2 connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experience

  • The GSR2 is a portable biofeedback system. This allows you to detect and amplify internal body activities that may be too subtle for normal awareness.

  • One of the main ways that the body reacts to tension and stress is through your skin. The GSR is merely a reflection of variations in your sweat gland activity and pore size, both of which are controlled by the sympathetic nervous system.

  • Skin resistance increases when you are clam and relaxed and the vice versa when you are tensed.


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  • The connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experienceGSR2 helps you develop the ability to control tension and stress, by giving you an auditory signal in response to your level of tension/relaxation. That is as you learn to relax your resistance increases and the tone of the GSR2 decreases, as you tense your skin resistance decreases and the tone becomes louder.


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Let’s Explore How Pain Has Affected Your Life connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experience

  • How has pain affected your work, play and ability to perform your daily activities?

  • What other symptoms do you experience in addition to the pain?

  • What are your thoughts and feelings in response to your pain experience?

  • What does being in pain mean to you?


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Goal Setting connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experience

  • A goal should be measurable

  • A goal should be observable/behavioral

  • A goal should be realistic

  • A goal should be desirable

  • A goal should focus on things I can control

  • Steps required to attain a goal need to be clearly outlined


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MIND-BODY CONNECTION connections with the cerebral cortex and limbic system, which allows the pain message to become a conscious and emotional experience

  • Mind and body are interconnected. This can be clearly demonstrated with the experience of stress. The mind perceives something as posing physical or psychological danger and in turn we experience physical and emotional reactions.

  • “Fight-or-Flight” – is the body’s automatic response to danger. During such times the SNS releases adrenalin, and the PNS secretes ACH.


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Mind Modulation of Cell Activity response:

  • Whenever a particular situation occurs the mind generates thoughts and imagery in the frontal cortex.

  • These thoughts-imageries are filtered through the memory of past experiences and emotional areas of the limbic-hypothalamic system and changed into the neurotransmitters that regulate the organs of the Autonomic Nervous System, which branches in the Sympathetic and Parasympathetic Nervous System.


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  • These neurotransmitters initiate the third stage in the process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • This path of information transduction is being modulated constantly and automatically on an involuntary, unconscious level by the state-dependent encoding of memory, learning and behavior from our daily life experiences.


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Mind Modulation Of The Endocrine System process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Information is processed in the frontal cortex, and then filtered through the individual’s repertory of experiential life learning that’s encoded in the limbic-hypothalamic system

  • The transduction of the this learning by the hypothalamus into the releasing factors that control/regulate the endocrine’s pituitary gland that in turn release a host of hormones which regulate the entire endocrine system of the body.


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Mind Modulation of the Immune System process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • There is clear evidence of how psychological stress can affect the expression of IL-2 receptor gene expression and IL-2 messenger RNA in white blood cells

  • Inhibiting or stimulating the hypothalamus results in changes in immunologic reactivity, also activation of an immune response in the body results in changes within the hypothalamus


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Mind Modulation of the Neuropeptide System process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • The limbic-hypothalamic locus of neuropeptide activity is enriched with opiate receptors, substance P, bombesin, CCK, neurosensin, insulin and transferin.

  • The brain stem and spinal cord include the modulation of sensory information. The dorsal horn were neurons transmit information from glands, skin, and other peripheral organs make their first synaptic contact with the CNS, here the neuroreceptors filter incoming sensory information so that the whole organisms perception of a particular event is compatible with survival.


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Effects Of Chronic Stress process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.Chronic Pain

  • Chronic stress or chronic pain causes the body to overextend itself in order to maintain balance, eventually it wears itself out, its recuperative abilities get exhausted. Symptoms like fatigue, headaches, poor concentration, SOB, weight loss/gain, increased muscle tension, anxiety/depression , sleep disturbance, GI problems, and reduced immunity.


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The Relaxation Response (RR) process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • It is voluntary

  • It can be achieved by focusing one’s mind or a repetitive phrase, breath or action

  • Adopting a passive attitude toward the thoughts that go through one’s head


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The Physical Effects of RR process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Immediate changes which occur while a person is focusing on a repetitive word; lowering of blood pressure, heart rate, breath rate and oxygen consumption.

  • Long-term changes, which take place after repeated practice for at least a month; alter the body’s response to adrenalin.


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RR Techniques process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Using a focus word or phrase

  • Coupling breathing with imagination

  • Progressive muscle relaxation

  • Using repetitive motion

  • Creating a safe place

  • Using hypnosis

  • Using visualization


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Using Breath To Relax and Focus Your Mind process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Chest Breathing

  • Diaphragmatic Breathing

    • Sit in a chair and clasp your hands behind your head; point your elbows out to the side

    • Place your hands just below your belly button; close your eyes and imagine a baloon inside your abdomen;

  • Breath focusing exercises


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Mind-Body Connection process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Let’s see how the body can affect the mind. This can be achieved by:

    • Pacing Yourself- engaging in an activity routine consisting of regular “uptime” and “downtime” periods will enable pain patients to increase their activity levels and decrease their pain over time.


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  • Listening to your Body- process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

    • Gently stretch your muscles

    • Gently move your limbs through their range of motion

    • Isolate muscle tension

    • Relabel sensations

    • Use breathing to release tension

    • Develop body awareness


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Let’s Explore Other Ways Your Body Affects Your Mind process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Push yourself by using denial of your condition

  • Withdraw from any type of activities

  • Ignore any sensations from your neck down

  • You rationalize painful sensations


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Pacing Yourself process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Alternate between more and less physically strenuous

  • activities.

    • Establish your pain baseline

    • Go up to no more than 1-2 points above your baseline, then

    • switch to a lower level of activity

    • Once you establish your “uptime and downtime” then you are

    • ready to pace yourself. So whenever you know you are going to

    • engage in a strenuous task time yourself.

    • As you do this consistently you will find that the “uptime”

    • lengthen and “downtime” will shorten.


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Common Problems With Pacing process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Difficulty deciding what you can and cannot do

  • Feeling guilty for not doing something and taking time for yourself

  • Experiencing delay in pain increases, as a result of “deconditioning”-combination of decreased muscle strength and endurance due to lack of exercise.

  • Don’t forget to remember that pain level does not necessarily correlate to your ability to function


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Time Management process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • How much time do you devote for your needs?

  • Do I need to be involved in all of the activities that I am, or am I

  • having a hard time to letting go?

  • What activities can I share or assign to someone else?

  • What activities that I am not currently pursuing would I like to

    add?

  • How much time do I have of high-quality recuperative time?


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Listening to Your Body process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Labeling sensations in your:

  • Legs

  • Arms

  • Stomach/chest

  • Shoulders

  • Head/face


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Rating Your Pain process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Learning to translate physical sensations into numbers.

  • Use scale of 1-10.

  • Procedure:

    • Make a fist, tighten it to a rating of 5; then make a fist tighten to a rating of 2; notice the difference

    • Relax the fist, wiggle your fingers;

    • Make a fist with a rating of 9; notice the difference

    • Relax your fist


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Using Your Body to Change Your Mood process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Posture and facial expression, they do change your mood!!

    • Raise your eyebrows

    • Show your teeth

    • Keep it for 30 seconds!


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Thoughts, Feelings & Sensations process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

“Do not wait for events to unfold as

you wish them to unfold. Decide to

want what occurs……and you will

be happy.”

Epictetus, 1st century B.C.


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Environment process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

Thoughts

Sensations

Feelings

Behavior


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Pain and Depression process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Depression- feeling sad, having trouble sleeping, loss of interest in various activities are common symptoms that can be indicative of the struggle one has to cope with pain, and the way pain interferes with your daily functioning.

  • Depressed people can complain of somatic problems, which subside when the depression is treated. In chronic pain patients with the treatment of depression, the pain does not go away but rather the pain experience changes.


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Pain and Anxiety process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Anxiety- feeling worried/fearful as a result of one’s perception of being in danger, threatened or vulnerable in some way.

  • Negative feelings that arise as a result of anticipating that something “bad” will happen.

  • Feelings that arise when one underestimates their ability to cope.


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Mind Over Mood process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

1. Identify thoughts and situations associated with depression and or anxiety

  • Situation: who, what, when, where

  • Mood: rate your mood

  • Automatic Thoughts


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  • Look for evidence that supports the automatic thought process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Look for evidence that does not support the automatic thought

  • Alternative Balanced Thoughts- combine 2 and 3.

  • Rate your mood again.


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Identifying Core Beliefs process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Core beliefs about SELF

  • Core beliefs about OTHERS

  • Core beliefs about the WORLD

    • Identify the situation

    • What does this mean about me?

    • What does this means about others?

    • What does this mean about the world?


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Pain, Guilt and Anger process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • Anger arises when we feel we have been treated unfairly, important rules and beliefs were ignored/violated, hurt unnecessarily, or prevented from getting something we expected to achieve.

  • Guilt arises when we feel we have violated basic beliefs or rules, blame ourselves for a particular situation.


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Ellis’s Irrational Beliefs process of information change from the thoughts, images and emotions of mind to the biochemical responses within the individual cells of the tissues and organs of the body.

  • It is an absolute necessity for one to have love and approval from peers, family and friends

  • You must be unfailingly competent and almost perfect in all you undertake.

  • Certain people are evil, wicked, and villainous, and should be punished

  • It is horrible when people and things are not the way you would like them to be


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  • You should feel fear or anxiety about anything that is unknown, uncertain, or potentially dangerous.

  • It is easier to avoid than to face life’s difficulties and responsibilities.

  • You need something other or stronger or greater than yourself to rely on.

  • The past has a lot to do with determining the present.

  • Happiness can be achieved by inaction, passivity, and endless leisure.


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Burn’s 10 Types of Cognitive Distortions unknown, uncertain, or potentially dangerous.

  • All-or-none thinking

  • Overgeneralization

  • Mental Filtering

  • Disqualifying the positive

  • Jumping to conclusions

    • Mind reading

    • Fortune telling


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Monitoring Automatic Thoughts unknown, uncertain, or potentially dangerous.

  • Identify situation your pain is increased

  • What do you say to yourself?

  • How do you feel physically?

  • How do you feel emotionally?

  • What thoughts are going through your mind? (irrational thoughts)

  • What might you say to yourself that could be realistic and situation focused? (reframe your thought)


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Reframing Technique unknown, uncertain, or potentially dangerous.

  • Identify your negative thought

  • Identify your irrational thoughts

  • State the problem e.g.. “I hurt when I walk”

  • State why it’s a problem, e.g. “I was planning to go camping”

  • What can I do? e.g.. “Take a shower, take my meds, practice my RR and pace myself”

  • What do I need? e.g.. “Tell my friend to go to a camping site where I can rest frequently, or maybe take some other activities that we can do while sitting.”

  • How do you feel now?


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Adopting Healthy Lifestyle unknown, uncertain, or potentially dangerous.

Problematic Attitudes

Learned Helplessness, anger and responsibility

Forgiveness; Naming the injury, Claiming the injury, Blaming the injurer, Balancing the scales, Choosing to forgive

Healthy Attitudes Stress; Stress hardiness, Optimism, Empathy

Building a foundation for attitude change

Affirmations, Sources of self esteem,

Humor.


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Stress Response unknown, uncertain, or potentially dangerous.

  • “Fight or Flight”-the body is biologically prepared to deal with threatening or dangerous situations. This is caused by the release of adrenalin from the Sympathetic Nervous System and other hormones such as Cortisol and Growth Hormone

  • When one’s body is overextended its capacity for homeostasis is compromised.


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Stress Symptoms unknown, uncertain, or potentially dangerous.

  • Decrease immune system

  • Sleep problems

  • Fatigue

  • Headaches

  • Poor concentration

  • Shortness of Breath

  • Weight loss/gain

  • Anxiety/Depression

  • Increased muscle tension

  • GI problems


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Important Elements in Stress Management unknown, uncertain, or potentially dangerous.

  • Problem Solving

    • What is your first goal?

    • Why haven’t you accomplished it yet?

    • What kind of self-talk do you engage in when you think about this emotion or the difficulty of the goal?

    • What is the source of the cognitive distortion?

  • Assessing & Applying Your Coping Skills

    • Physically Focused Coping- exercise, labeling sensations, RR

    • Emotion Focused Coping- RR techniques, negative thoughts, communication

    • Problem Focused Coping- setting goals, pleasurable activities, brainstorming, social support


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How To Cope With Stress unknown, uncertain, or potentially dangerous.

  • Make stress management a priority

  • Establish a safe, comfortable place

  • Use breathing and “word focus”

  • Progressive Muscle Relaxation

  • Repetitive Motion


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- unknown, uncertain, or potentially dangerous.continued-

  • Visualization

  • Symptom Substitution

  • Redirection

  • Dissociation

  • Reframing your Thoughts/Developing Different Attitudes


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Power of the Mind unknown, uncertain, or potentially dangerous.

  • Self-Talk, Mood, Environment

  • Monitoring Automatic Thoughts & Negative Attitudes

  • Reframing Your Thoughts/Developing Different Attitudes

  • Medication and Chronic Pain

  • GSR2 and Muscle Retraining


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Pain and Relationships unknown, uncertain, or potentially dangerous.

  • Pain and Activity

    • Type of activity

    • Intensity of activity

  • Pain and Intimacy

    • Impact on self-image

    • Impact on one’s sex life


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Pain and Activity unknown, uncertain, or potentially dangerous.

  • What do you like to do for fun?

  • The new challenge! What else might I enjoy doing?

  • Pace yourself!

  • Talk with your friends

    what is less uncomfortable


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Pain and Intimacy unknown, uncertain, or potentially dangerous.

  • Pain and Sexual Issues

    • Communication and awkwardness

    • How to approach the problem

      • Be willing to talk

      • Don’t assume anything

      • Use words that are comfortable to you

      • Plan ahead

      • Pace yourself

      • Express to your partner how you feel about the experience your share


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Intimacy and Communication unknown, uncertain, or potentially dangerous.

  • Important to express

    “openly” to your partner

    what makes you feel

    more comfortable

  • Share your concerns


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Sleep Disturbances unknown, uncertain, or potentially dangerous.

  • There are 5 stages of sleep

  • During a good night’s sleep,

  • one progresses from Stage

    1 to stage 4 and then to REM

    sleep in about 90 minutes

  • A good sleeper will move

    through 4-5 of these 90

    minute sleep cycles


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-continued- unknown, uncertain, or potentially dangerous.

  • During the early part of sleep, deep-sleep periods are lengthier, sometimes lasting up to one hour, whereas REM periods last only a few minutes

  • As the night goes one the deep-sleep periods become shorter and the REM periods increase,so that by the final cycle REM periods may last for an hour.


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Factors Affecting Sleep unknown, uncertain, or potentially dangerous.

  • Stress

  • Medical Problems-angina, asthma, allergies, indigestion, arthritis, headaches, epilepsy, hyperthyroidism, kidney disease, diabetes and hypoglycemia, dementia.

  • Drugs- analgesics that contain caffeine I.e. Anacin, Excedrin, diet pills, steroids, beta-blockers, nasal decongestants that contain stimulants, asthma medication that have stimulating effects, thyroid hormones, some antidepressants.

  • Mental Health Problems- depression(early awakening, excessive REM sleep and reduced deep sleep); anxiety


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Sleep Disorders unknown, uncertain, or potentially dangerous.

  • Sleep Apnea- breathing stops from 10” to several minutes, which causes the heart to work harder in order to keep the blood oxygenated. So sleep apnea is a risk for hypertension, strokes, and heart disease. CPAP allows continuous passage airway pressure.

  • Periodic Limb Movements (PVM)-involves kicking twitching of limbs repeatedly.


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-continued- unknown, uncertain, or potentially dangerous.

  • Restless Legs- unpleasant sensations in the legs, primarily in the calves, described as a creeping or crawling sensation.

  • Delayed Phase Disorder-person cannot fall asleep until 3-4:00am, but then can sleep well for 7-8 hours

  • Nightmares- usually occur in the second half of the night, when dream sleep is more prominent


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Sleep Myths and Self-Talk unknown, uncertain, or potentially dangerous.

  • 8 hour myth. 20% of population sleeps 6 hours or less. Core sleep- 5.5 hrs of sleep contains 100% of our deep sleep.

  • Negative sleep thoughts vs. Positive sleep thoughts I.e. “I don’t think I can fall back to sleep” vs. “I always fall back to sleep”; “I am not sleeping enough hours” vs. “If I get my core sleep, I’ll be able to function during the day.”


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Establishing Sleep Promoting unknown, uncertain, or potentially dangerous.Habits

  • Sleep scheduling techniques

    • When you go to bed

    • When you get out of bed

    • How much time do you spend in bed

  • This is related to two concepts:

    • Prior Wakefulness-amount of hrs that elapsed from the time you got out of bed to the time you turn off the lights at bedtime. The greater the amount of prior wakefulness, the greater the brain’s pressure for sleep and the better we sleep.

    • Sleep Efficiency-is the ratio of the time asleep divided by time spent in bed


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What Can You Do To Improve unknown, uncertain, or potentially dangerous.Sleep Patterns

  • Get out of bed around the same time every day, including weekends, no matter how little or poorly you have slept

  • Reduce your time in bed so that it more closely matches the amount of sleep you area averaging per night.

  • Determine your maximum allowable time in bed by simply adding one hour to your average sleep time. Once you have attained/maintained an 85% of sleep efficiency for two weeks, you can increase time staying in bed by 15 minutes/week.

  • Napping in mid-afternoon is very therapeutic, just limit it to under 45 minutes, otherwise you may enter deep sleep which will interfere with night sleep.


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Stimulus-Control Techniques unknown, uncertain, or potentially dangerous.

  • Use the bedroom for what is intended. If you read

    or watch television limit this to 30 minutes.

  • Since your goals is to

    associate the bed with sleep,

    make sure you feel drowsy

    when you turn the lights off

    to go to sleep.

  • Comfortable bed, right

    temperature.

    .


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-continued- unknown, uncertain, or potentially dangerous.

  • If you don’t fall asleep within 20-30 minutes or if you awaken during the night and don’t fall back to sleep within that time, don’t lie in bed tossing and turning, instead leave the room or engage in a quiet activity as long as you go to sleep within an hour, otherwise you will associate the bed with wakefulness


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Stress and Insomnia unknown, uncertain, or potentially dangerous.

  • Increased amount of stress hormones such as adrenaline that activate the NS and put us “on edge”

  • Increased heart rate, BP and respiration for greater physical strength and energy

  • Heightened sensory acuity and faster brain waves for enhanced alertness and mental reactions

  • Decreased blood flow to the stomach and extremities; increased blood flow to the brain, muscles, heart and lungs to assist in fighting or fleeing

  • Increased muscle tension to spring to action

  • Increased sweating to cool the body

  • Increased blood-sugar levels to reduce fatigue and increase energy


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What Is Anxiety? unknown, uncertain, or potentially dangerous.

  • Irrational worry and avoidance of situations that are the focus of this worry

  • Anxiety is a warning signal; it warns us about an impending danger.

  • It is different than fear which is in response to a known, external threat.


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Psychological & Cognitive Symptoms Of Anxiety unknown, uncertain, or potentially dangerous.

  • The experience of anxiety has two components:

    • Awareness of physiological sensations

    • Awareness of being nervous/frightened

  • Anxiety affects visceral and motor functions, as well as it affects thinking, perception and learning. It causes confusion and distortion of perception, not only of time and place but also of people and the meanings of events

  • Anxious people tend to have selective attention.


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Coping With Anxiety unknown, uncertain, or potentially dangerous.

  • How one copes in stressful

    or anxiety provoking

    situations depends on

    whether they perceive

    that they have control

    over their environment

    and or situation.


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Facts About Anxiety unknown, uncertain, or potentially dangerous.

  • Most people become anxious when threatened by loss of love, position, wealth or safety.

  • Anxiety is a future oriented state. It involves worrying about something that might happen “what if”

  • Anxious people obsess about what they cannot control, instead of paying attention to what they can control.


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Anxiety and Issues of Control unknown, uncertain, or potentially dangerous.

  • “Illusion of Control”- with the advance of technology, man has been able to control a number of events giving one the illusion that we can control more things than we actually can

  • Fear of losing control- believing that one has to control their emotions if they are strong.

  • Anxious about being anxious. The worst fear is the fear of fear!


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Anxiety and Social Learning unknown, uncertain, or potentially dangerous.

  • We are the product of the interactive effect of our genetic structure and our environment. The way we think, view and interpret various situations, is based on what we have learned through our lifetime, our background and experiences

  • Anxiety is accompanied by the perception that we are in danger or that we are threatened, or something is about to happen. The perception of threat varies from person to person.

  • Anxious thoughts are future oriented and often predict catastrophe.


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How To Control Your Anxiety unknown, uncertain, or potentially dangerous.

  • Identify and alter the thoughts that accompany anxiety and panic

  • Learn techniques such as cognitive interventions, relaxation training, imagery and behavioral methods to alleviate anxiety

  • Cognitive Restructuring involves changing one’s perception of how and what is perceived as dangerous and increasing one’s confidence in their ability to cope with that particular situation. Assess the situation, what thoughts are behind it, what mood are you in and what behaviors do you engage.


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Anxiety And Avoidance unknown, uncertain, or potentially dangerous.

  • Recognizing that when a situation is anxiety provoking one tends to avoid it, as a result one initially experience a decrease in anxiety by avoiding that which is anxiety producing.

  • Learn to approach and cope with situations in which we feel anxious is a lasting and powerful way of eliminating anxiety.

  • Gather evidence about the accuracy of his or her catastrophic expectations and thus reassess their perception regarding their fear

  • Establish a hierarchy of the situations, events, or people you fear and start from the bottom-the basically non-anxiety, relatively safe situation.


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Depression And Pain unknown, uncertain, or potentially dangerous.

  • Biological-

    • low concentration of neurotransmitters

    • certain prescription drugs

    • recreational drugs

    • neurological diseases

  • Psychological

    • irrational thinking

    • faulty learning


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Cognitive Dimension of Depression unknown, uncertain, or potentially dangerous.

  • negative self-evaluation

  • hopelessness & helplessness

  • negative interpretation of events

  • indecision, confusion, rigidity

  • cognitive distortions, rumination

  • suicidal ideation

  • perceptual amplification or minimization


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Affective Dimension of Depression unknown, uncertain, or potentially dangerous.

  • ambivalence, sadness, guilt

  • loss of emotional attachments

  • feelings of powerlessness

  • increased irritability, anger

  • loss of motivation, anhedonia

  • feelings of inadequacy, poor self-esteem

  • focus is primarily on depressed feelings


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Relational Dimension of Depression unknown, uncertain, or potentially dangerous.

  • dependent on others

  • victim role

  • isolation, avoidance

  • over responsible for others

  • hypercritical of others

  • difficulty with identifying and expressing feelings


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Skills Needed To Overcome Depression unknown, uncertain, or potentially dangerous.

1- Learning how to relax

2- Increase the number of pleasant activities

3- Learn how to change/relate in various social situations

4- Learn how to be aware and change your negative thinking

5- Learn how to approach problems more constructively


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Steps Needed For Self-Change unknown, uncertain, or potentially dangerous.

  • specify the problem and decide what to change

  • gather information regarding the problematic behavior

  • discover antecedents and consequences

  • decide what goal you want to achieve

  • contract to reward yourself for each step you achieve

  • chart your progress


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Comfort Measures & Social Support unknown, uncertain, or potentially dangerous.

  • You are the expert of your body!

  • You know what makes it

    feel more or less

    uncomfortable!


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Support Systems unknown, uncertain, or potentially dangerous.

  • Family Support

  • Community Support

  • Spiritual Support


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How To Improve Your Support unknown, uncertain, or potentially dangerous.

  • Recognize that pain can make you feel abandoned

  • No one has a satisfactory answer to questions about hurt and pain

  • Talk and or prayer can help

  • Tell yourself you have a lot to offer

  • Praise yourself for being flexible and adjusts to change


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How To Maximize Your Gains unknown, uncertain, or potentially dangerous.

  • Maintain a daily routine of muscle retraining

  • Keep a daily record of pain levels, and type of activity involved

  • Learn how to be “smart” about your pain

  • Recognize signs of relapse


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How To Be Smart About Your Pain unknown, uncertain, or potentially dangerous.

  • Work toward control- aim to be in control at least 50% of the situations

  • Be prepared- anticipate what might happen in a particular situation, and prepare for it.

  • You know best- listen to your body, if you are having a bad day, don’t be talked into something that might make it worse!

  • Is it worth it?- sometimes you may decide to do something even if it is not recommended. The important part is to recognize the consequences ahead of time


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- unknown, uncertain, or potentially dangerous.continued-

  • I know it will hurt, but I am going to be ready- have a recovery plan ready that will help ease your pain

  • What else can I do?- is there anything else to do but look at the stars?

  • What matters is now- take it one minute at the time, worrying about the future can only make one anxious and more tensed.

  • I want to control everything, but- recognize what you can control; and although you can change the past you can control how you react to it.


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-continued- unknown, uncertain, or potentially dangerous.

  • I know what I am dealing with, therefore I can- knowing what you are dealing with is a sign of strength, because you can focus on what you know you can do and do it.

  • Remember your 3 P’s:

    • Pick what you can do

    • Plan what you do

    • Prepare for what will happen


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Problem Solving unknown, uncertain, or potentially dangerous.

  • State the problem

  • Outline the problem

  • List possible solutions

  • View the consequences

  • Execute your solution


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State The Problem unknown, uncertain, or potentially dangerous.

  • Prioritize what is affecting you the most;

  • Give it a rating from 1-10; 10 = it is really affecting me.


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Outline The Problem unknown, uncertain, or potentially dangerous.

  • Describe the situation clearly:

    • Who is involved?

    • Where does it happen?

    • When does it happen?

    • What are the antecedent events?

    • What are the consequences?

    • What role did I play in it?


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Solutions unknown, uncertain, or potentially dangerous.

  • Think outside the box!

  • The more comfort tools

    the better!

  • Brainstorm and then

    clarify!


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Consequences unknown, uncertain, or potentially dangerous.

  • How will this solution affect me or others?

  • Is it a long-term solution, or just a band-aid?

  • How likely is it that I will follow through?

  • How will I feel about it?

  • Will I have the support of my family, friends, others?


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Go Ahead With Solution unknown, uncertain, or potentially dangerous.


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