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coping with stress - Coping with Stress and Pain(see...

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Unformatted text preview: Coping with Stress and Pain (see Brannon & Feist, Chapter 8; Gatchei & Ordt—rnove charts to a handout? They have this assigned readings) Personal coping strategies Problem focused coning; aimed at changing the source of the stress {e.g., taking action, making plan, asking for help} Emotion—focused coning: aimed at managing emotions related to the stress (e.g., venting, getting support. diversion/detraction) I Each can be useful depending on type Oi‘strcssor n In general, probiern focused (when possible) associated with more positive psychological and medical health benefits. Emotional Disclosure: Outcomes Back to stress Kobasa (1977) Hardiness: u Executives followed for 3 years and divided into those who suffered disease and those who didn’t - Nonwhardy executives (vs. commitment, control, challenge): 1 Locked purpose in life :- Locked vigor n Believed that lives were beyond their control I Felt powerless :- Felt alienated from self I More recently hardy health care workers showed less stress and lower level of exhaustion and job burnout (e.g., Sciacehitano et at, 2001) Dealing with stress: Emotional disciosure - Disclosure {in ways that involved self- rcflection and processing ) of traumatic events by writing or talking about them a Pennebaicer: write about it for 15—20 minutes, 3-4 it per week. a Students writing about entering college have fewer illnesses - Asthma and arthritis patients who keep journal of stressful events over4 months improved function compared to a control (writing on neutral topics) Emotional disclosure I: Other outcomes: improved immune function, decrease physician visits, lower rates of asthma, arthritis, cancer and heart disease, better grades in college students, enhanced sense of wellbeing, increase ability to find new jobs (Pennebaker & Graybeal, 2001) Social Support I Material and emotional support an individuai receives (also see Gatchei-Chl3 reading) I Persons with high ievel of support usually have a broad social network I includes emotional? sopport, advice, and companionship as well as tangible assistance of various types (financial, material) Par: )/ Smut-g l‘airL .iati (.1: :io 5' l '9 Social support can buffer the effects of stress However, other factors such as belieis and patterns of meditate, etc. can also significantly influence stress levels. Because these same factors also are relevant to the experience and treatment ofpain, let’s turn out attention to pain. Coping with pain and stress: Social support Lack of support as strongly linked to mortality as cigarette smoking and sedentary lifestyle (Beriqnan & Syme, 1979) Those with fewest social} ties 2-4 x more likeiy to die (Alameda County study). Marriage benefits men more than women Marital conflict strong source of stress (maybe more for women) Too many supports for women is detrimental How does support have effects? I Support may encourag e healthy behaviors I Supported people may gain confidence in their ability to handle stress and are less threatened by stress because of that (less distressed with stress) People who feel in control seem to handle stress better than those who do not feel in control. Gate control theory Neural mechanisms (fibers) in the spinai cord like a gate to open or close neural impulse flow Sensogg input is subject to modulation depending on fibers noted above Input from brain also influences gate (cg, experience ofpain influenced by beliefs, prior experience, etc.) Increased pain (open gate) due to anxiety, worry, depression, focus on injury Decreased pain (closed gate) due to distraction, relaxation, positive emotions Gale Control Theory of him To Explain wily thouyus and emotions influence pain perception, Ronald Mctzack and Patrick Wall proposcd let a gating mechanism exists within the dorsal hum of the spinal coral Small nerve fibers (pain receptors) and large nerve fibers ("nonna|" mceplors) synapse on projection cells (P), which go up the spinnthalamic tract lo the min, and inhihilory interncnmns (l) withth the dorsal horn. {sea illustration below) The interplay among these connmtions dctcmmcs when painful stimuli go to :he brain: When no input corms in; the inhibitory neuron prsvcms the projectim neuron from sending signals a: die brain (gate is close/d), fiber slimnialiuri), Both the inltibilm'y neuron and film projection ncumn are stimulated) but Lin: mliibiiory neuron prnvcnls the projection neuron from sending signals to the brain (gnu: is closed), Nociccglim (vain reception) happens when there is more small—fiber stimulation or only small: libsr stimulation. This imam-alas the inhibitory neuron, and the prnicntim neuron sends signals to Lhc brain infoming it of pain (gate is open). Descending, palhways from the brain close the gate by inhibiting the arojcotcr neurons and dimini§iing pain perceplbn. This theory doom”: tell us cvemliing about pain parseptim, but it does explain some things. if you rub or shake your hand after you hang your finger, you stimulate normal somatomnsow input Lo the projector neurons This opcns the gate and reduces the pcrccptim of pain Chronic Pain Syndrome Pain is no longer a symptom ofinjury Distinct from chronic or intermittent painful disease (where the level of fonction and behavior fit with injury) Subiective and behavioral manifestations of pain persist bevond objective evidence: of tissue injury Not all people with chronically painful conditions manifest chronic pain behavior and disability Coping with stress and pain: Relaxation training Various types: Progressive Muscle Relaxation, imagery, meditation, mindfulness meditation About l0 sessions sufficient See table to follow: useful with tension headaches, postoperative pain, chronic pain and anxiety, bum pain, chemotherapy effectse migraines _ .Nd mun? m (-25.11: CLOSEID For more detailed information on Gale Theory. do a Search on tins topic on the lmcrnci Pain warrants treatment (Krokosky & Reardon, I989) I Nurses and doctors underestimaie patient pain a Health care workers appear to undemodicate pain Result: now required to assess pain regniarly like blood pressure (scales, behavioral observation) I Since 1970’s self administration of pain meds helpful (adulzs and children): average medication use lower than with standard dosing l Risk ofaddiction less than 1% I Opiates for some, acute injuries, surgical recovery and terminal iilness Relaxation Outcomes Coping with stress and pain: Hypnotic treatment Altered state of consciousness where suggestiblepeople can control physiological processes (til-cc extremely deep state of relaxation) Peopie vary in ability to be hypnotized Most research on headaches, cancer pain (anxiety,pain, nausea, vomiting}, and burn pain (28 studies—ndoes not speed healing} Also used with surgery, chiiébirth (pain and stress reduced), dental work, and tow back treatment Decreases reported pain, distress and need for pain meds. Meta-analysis pain reduced in about 75% participants Biofeedback Outcomes Behavior Modification: Outcomes Ceping with stress and pain: Biofeedback Aiiows physiological responses to be tracked and presented so person can learn to control them I EMG —tension in skeletal muscies n Thermal feedback - Effective for several problems (migraine and tension headaches, low back pain, hypertension) c.g., reiaxation pins thermal biofeedback results in 50% reduction in pain with headaches (both types) :- Generally not viewed as sufficient alone and often not better results than relaxation or hypnosis Coping with stress and pain: Behavior Modification Positive and negative reinforcement can influence pain experience and related behavror. E.g., rewards szzch as attention, sympathy for pain behavior; removal of negatives such as relief from pain with medication or relief of reSponsibilities/obligations Goal: Reinforce desirable behaviors (and do not reinforce undesirable behaviors} (implications for PT?) Outcomes amount of medication used, absences from work? complaints, physical activity, time in bed/off feet, range ofrnotion, sitting tolerance Study with LOW Back pain a Patients with iow back pain in Sweden :- Randomly assigned to traditional care or a graded activity program where physical therapists praised non-pain behavior and ignored pain behavior a Experimental group returned to work an average of 6 weeks earlier and gained more confidence in their abiiity to work. even if feeling pain. Experimental group more active at 1 year follow-up. - Lindseom ct 31.. 3992 Professional coping with stress and pain: Cognitive Therapy I Uses reinforcement but more emphasis on intrinsic or self-reinforcers - Emphasizes the role of beliefs, personal standards and self-efficacy in influencing behavior In Focus on changing cognitions {beiiefs attitudes) Cognitive Therapy - Dispute catastrophic beliefs and make thinking more rational —) reduces stress I Persons with rheumatoid arthritis with reiated pain who catastrophized reported more intense pain, increased functional impairments, and greater depression (Keefe et 211., l989) Cognitive Therapy: Pain Inoculation and Stress Inocuiation Training - STEPS FOR PIT/SIT: - Reconccptnalizstion: accept a role for psychologicai factors - Aconisition and [cheafiélii ieam reiaxation anti cont-roiled breathing to manage pain (stress), imaging, nientai distraction {pleasant scene, count ceiling tites, etc.) members to ignore pain behavior and reinforce gradual increases in adaptive behavior (erg, increased activity, decreased use of pain meds, fewer visits to clinic, increased (lays at work), and create a plan for dealing with future pain and applying new skiils to other parts of tiaiiy iife C0ping with stress and pain: Cognitive therapy It Focuses on interpretations and how they change emotional and physiological reactions - Pain patients may exaggerate their pain—related thoughts and thus add a psychological component that increases their subjective feelings of pain {Gate Theory) Cognitive Therapy: Pain inoculation ”and Stress inoculation Training (draw on inoculation technigues) e Introduce pathogen (pain or stress) and build tolerance/immunity against high levels s Get to think differently about source of pain and experience (cognitive—change self talk) Cognitive Therapy: Outcomes Cognitive Therapy: Effects Oflcn pan of a multimodal program (as with PIT and SIT) CBT appears effective with: low back paw (betier than behavioral IX alone), for children with abdominal pain (versus standard pediatric care), rheumatoid anhrfiis, cancer and AIDS pain, headache: pain, terminal illness Mcla~analysis (Saunders et ai, E996) 0f 40 studies: inoculation (Taming decreased anxiety anti increased performance under stress PIT used in athletes with knee mjury pain (Ross & Berger, l996] Across studies, still better than comparisons at 1 year follow- up Cognitive Restructuring Activity In How is it coming? as Questians/problems? ...
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