Touching the Mind Mental and Mood Disorders for Massage Therapists

Size: px

Start display at page:

Download "Touching the Mind Mental and Mood Disorders for Massage Therapists"

Ernest Lester
5 years ago
Views:

1 Touching the Mind Mental and Mood Disorders for Massage Therapists What Are Mood Disorders? DSM-5 International reference Not infallible, but provides a common language among health care providers We will focus on Anxiety disorders OCD and related disorders Trauma and stressor related disorders Depressive disorders Bipolar and related disorders WHAT WE CAN DO Anxiety Disorders Definition Collection of of distinct psychiatric disorders centered on irrational fears Often overlap Range from mild to completely debilitating Demographics Estimated that up to 40 million people in the US have some sort of anxiety disorder; only a small proportion of them are treated Etiology Interpretation of environment leads to constant questioning of basic safety Am I safe? (probably not) Contributing factors: Genetics History of traumatic events Situations that form Arousal: Preparation for possible stressful event Fear: Stressful event is confirmed Anxiety: No discernable threat, but constant preparation for disaster 1

2 Can make it impossible to participate in society Lower socio-economic standing Limited access to help Increased risk for several other conditions Addiction Depression Many others Neurotransmitter imbalance High in excitatory NTs Norepinephrine GABA Low in inhibitory NTs Serotonin Dopamine The limbic system and the HPA axis The limbic system determines a person s sense of safety in any given moment. Two regulatory centers: the amygdala and the hippocampus. Hippocampus: center for verbal memory Amygdala: catalogues a history of fear responses Together: they stimulate the HPA axis HPA axis: hypothalamus + pituitary + adrenal gland Chemical/electrical connections to allow an appropriate response to a stressor Excessive glucocorticoid secretion (cortisol) with prolonged stress Shrinks hippocampus Enlarges amygdala (May be irreversible) Problems connecting stimuli to appropriate responses? 2

3 Types of Anxiety Disorders General anxiety disorder Panic attack, panic disorder Agoraphobia Phobias Social phobia Specific phobias Separation anxiety General Anxiety Disorder Constant anticipation of disaster Does not limit activities, does limit quality of life Symptoms: 6 months + of Restlessness Being on edge Fatigue Poor concentration Irritability Muscle tension Sleeping problems Panic Attack, Panic Disorder Sudden onset of extreme sympathetic response symptoms Pounding heart Chest pain Sweatiness Dizziness Faintness Flushing/chilling Hyperventilation Feeling of impending doom 10 minutes to several hours Can become circular: panic leads to panic Repeating episodes = panic disorder Can complicate to agoraphobia, which is harder to treat Agoraphobia Affects about 1/3 of people with panic disorder Defined as fear of open spaces Better: fear of any place a panic attack might happen Safety zone shrinks 3

4 Social Phobia, Social Anxiety Disorder Intense, irrational fear of being judged Can be debilitating Symptoms develop in childhood Blushing Sweating Trembling Nausea Women > men Separation Anxiety Associated with young children Often missed in adults (occurs with other disorders) Can be debilitating Can limit treatment success for other anxiety disorders Treatment for Anxiety Disorders Usually a combination of medication and psychotherapy Some respond better to psychotherapy and help with coping skills; not to medication Most can be successfully treated, if the patient has access to care Psychotherapy: Controlled exposure to frightening stimuli Cognitive-behavioral therapy Etc Also Relaxation, meditation, yoga, massage therapy Medications Antidepressants; anti-anxiety drugs; beta-blockers Antidepressants include SSRIs, tricyclics, MAO inhibitors Benzodiazepines for sedation (risk of dependence) Buspirone for sedation Beta-blockers for symptoms of panic disorder 4

5 Massage Therapy Implications Risks: Some patients may have a history of abuse that makes receiving massage a trigger. It is important that people feel safe in the massage therapy environment. Benefits: Massage therapy may help clients feel calmer, more able to cope with day-to-day stressors Massage Therapy Implications Options: Be flexible to meet these clients special needs; they may need to stay dressed, have another person in the room, etc. Research: Massage has been shown to be effective for anxiety as a freestanding disorder, and as a reaction to stressful situations like surgery. OCD and Related Disorders Definition Conditions that used to be classified as anxiety disorders Now considered unique due to predictable patterns of preoccupations and repetitive behaviors (obsessions + compulsions) Demographics About 2.2 million in US Men = women Etiology Focus on unwelcome thoughts/ repetitive behaviors Etiologies vary Family tendency Triggered by a specific event Some problems with serotonin production or uptake 5

6 Types of OC and Related Disorders Obsessive-compulsive disorder Body dysmorphic disorder Excoriation disorder Trichotillomania Hoarding disorder Obsessive-Compulsive Disorder Combination of Intrusive, unwelcome thoughts (obsessions) Rituals to try to control thoughts (compulsions) Many hours invested every day Examples of obsessions: Fear of contamination (dirt, germs, sexual activity) Fear of violence, accident; fear of committing violent or sexual acts Fear of disorder, asymmetry Examples of compulsions: Hand washing Refusing to touch things Repeatedly checking locks, light switches, on/off buttons, etc Counting things (i.e., telephone poles) Repeating words, phrases, prayers Body Dysmorphic Disorder Extreme unhappiness, anxiety because of a real or imagined flaw Beyond insecurity impacts ability to be able to function in society Can lead to other OCD-type disorders, depression Excoriation Disorder AKA skin-picking disorder Picking at the skin, especially on or near the face, to the point of self-injury (which leads to more picking) Efforts to stop are unsuccessful Can impair social functioning Infection, permanent scars are frequent 6

7 Trichotillomania Hair-pulling Closely related to excoriation disorder People feel anxious, pull at head hair, eyebrows, beard hair, body hair Sometimes complicates to hair-eating Hoarding Disorder A person is reluctant to part with possessions Unconnected to objective value Becomes a problem when Causes distress to person or partners Interferes with normal daily activities Causes physical risks (fire, falling, hygiene, etc.) Treatment for OCD and Related Disorders Combination of psychotherapy + medication Exposure/response prevention Antidepressants, anxiolytics Massage Therapy Implications Risks: Be aware of the client s triggers, and work to accommodate them. Extra care in communication is essential. Benefits: Welcomed massage therapy may help with a sense of self-efficacy, ability to cope. Options: Be flexible, imaginative, and versatile to meet the special needs of these clients. Research: Massage therapy is well accepted as a useful intervention for anxiety disorders in general; OCD and related disorders could be considered part of this group. Trauma and Stressor Related Disorders Definition Collection of conditions previously categorized as anxiety disorders Different diagnostic criteria, so now considered free-standing Some suggest that PTSD should be called posttraumatic stress injury (PTSI) to lessen the stigma 7

8 Demographics Can develop at any age Special criteria in children 4% of boys 6% of girls About 30% of people who have been in war zones Women appear to be more susceptible than men Etiology A life-threatening event can change brain function Sympathetic and hormonal changes become persistent Normal inhibitors don t work Factors: How close the event was; how long it lasted, how severe it was Characteristics of the person What happens in the posttraumatic period Types of Trauma and Stressor Related Disorders Posttraumatic stress disorder (PTSD) Dissociative PTSD Acute traumatic stress disorder Adjustment disorder Reactive attachment disorder Posttraumatic Stress Disorder PTSD, PTSI Experienced by a person exposed to Death Actual or threatened injury or violence Could be a participant or live witness Also affects Relatives, people close to the person in trauma First responders and caregivers Dissociative PTSD Person who feels detached from him mind and/or body The world seems unreal, distorted (this distinction calls for different treatment options) Acute Traumatic Stress Disorder Looks like standard PTSD Develops more quickly after the event 8

9 Can still have long-lasting consequences Adjustment Disorder Acute or chronic reaction to a stressor, can be a precursor to PTSD Stressor does not have to be severe Reactive Attachment Disorder Childhood stressor interferes in future coping skills Pathologically withdrawn, inhibited Reduced response to environment Poor self care Signs and Symptoms 4 types of symptoms: Re-experiencing Flashbacks, nightmares Avoidance Efforts to avoid stressful thoughts, situations Negative beliefs and mood Self-blame, lack of trust, feeling alienated from others Arousal Hypervigilance, poor sleep, aggressive behavior, exaggerated startle response Treatment for Traumatic and Stressor Related Disorders Combination of group, individual, family therapy Medication Antidepressants, beta-blockers, sleep aids Best if instituted early Frequent overlap with addiction, depression these must also be treated Massage Therapy Implications Risks: Main risk is triggering a flashback or other reaction. In the event of a dissociative episode, stay present and attentive; try to bring the client back to the present. Benefits: Massage may be helpful for people with PTSD and related disorders to feel better connected to themselves and their world. It is an important exercise in trust. Research: If people are comfortable with touch, research shows that massage therapy can be a helpful addition for people with PTSD and survivors of other 9

10 ordeals. Depressive Disorders Definition Group of disorders marked by negative changes in mood state Main factors: Genetic predisposition Chemical changes Triggering event Inability to experience pleasure (anhedonia) A genetic-neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets. Demographics 20% of women in US 12% of men in US Highest among those years old Etiology Not well understood Neurotransmitters, especially serotonin, dopamine, norepinephrine In short supply, and/or receptors are unreceptive Medication works to make them more available Hypothalamus-pituitary-adrenal axis (HPA axis) Depressed people appear to have more stress responses, to smaller triggers, with more prolonged effects compared to other people Other factors: Personal chemistry Genetics Environment, emotional triggers Personality and emotional resilience Often overlaps other disorders Treating depression may make treating other conditions more successful Complications Suicide risk 30,000 successful suicides/year in US 200,000 attempts About ½ are related to depression Men have depression less often, but are more likely to commit suicide 10

11 Risk factor for Addiction Stroke Heart attack (Also a predictor for recovery) Can make other chronic conditions worse Types of Depressive Disorders Major depressive disorder Persistent depressive disorder Psychotic depression Seasonal affective disorder Premenstrual dysphoric disorder Postpartum depression Major Depressive Disorder Classic example, most common form Severe symptoms persist for 2 weeks or more Episodes may last 6-18 months Recur 4-6 times over a lifetime (adds up to 10 years or more) Each episode may be triggered by a smaller event Persistent Depressive Disorder Depressed mood for 2 years or more Less severe than major depressive disorder, longer lasting AKA dysthymia Psychotic Depression Major depressive disorder with psychosis Hallucinations (distortions of perception) Delusions (beliefs that are not changed by reason or contradictory evidence) Seasonal Affective Disorder Depression related to lack of sunlight Incidence related to distance from the equator May be related to low melatonin Premenstrual Dysphoric Disorder Type of premenstrual syndrome that includes signs of major depressive disorder with monthly cycles 11

12 Postpartum Depression Affects new mothers, within a few months of giving birth Vast hormonal shifts Inadequate social support Biologic vulnerability Symptoms of major depressive disorder with fear of harm or doing harm to the baby Postpartum psychosis is different: involves hallucinations and delusions that may put mother and child at risk Signs and Symptoms Depends on type Mainly: Sad, empty feeling Not experiencing pleasure, enjoyment Also Guilt, disappointment Hopelessness Irritability Change in sleeping habits, change in eating habits Decreased ability to concentrate Loss of energy General pain Suicidal ideation Treatment for Depressive Disorders Most cases are treatable Finding the right treatment can be difficult Start with exercise, sleep, food habits Medications may require several weeks to take effect Side effects in the meantime Important to treat fully to prevent complications, recurrent episodes Talk therapy, including Cognitive-behavioral therapy Interpersonal therapy Psychodynamic therapy 12

13 Other treatments: Light therapy (especially for SAD) Electroconvulsive therapy St. John s wort S-adenosyl-methionine (SAM-e) Omega 3 fish oil 5-hydroxytryptophan Transcranial magnetic stimulation, vagus nerve stimulation Medications Antidepressants work to keep key neurotransmitters present in synapses for as long as possible Selective serotonin reuptake inhibitors Serotonin norepinephrine reuptake inhibitors Tricyclic antidepressants Monoamine oxidase inhibitors (have potentially dangerous interactions, requires special care) Anti-anxiety medication may also be used Massage Therapy Implications Risks: No specific physical risks, but tend the therapist-client relationship carefully. Clients may want to go off medication if they feel massage therapy helps; they must do this with the assistance of their physician. Benefits: Massage appears to improve mood, anxiety and the sense of the ability to cope with life stressors. Research: Massage has been shown to help with depression as a freestanding disorder and as a part of chronic diseases. 13

14 Bipolar Disorders Definition AKA manic depression Marked by mood swings from major depression to mania Demographics Affects about 2.6% of US adults 2.3 million people Of those affected, 83% have a severe form Often appears in late adolescence Men = Women Men are more likely to be misdiagnosed with schizophrenia Women are more likely to be misdiagnosed with major depressive disorder Etiology Etiology is not well understood Appears to run in families Differences in brain development during adolescence may trigger symptoms Demyelination in areas of the brain that manage emotion Types of Bipolar Disorders Bipolar type I Bipolar type II Cyclothymia Mixed bipolar disorder Rapid-cycling bipolar disorder Bipolar Type I Most common form Diagnosed when Manic for 1 week Depressive for 2 weeks Hospitalization, impaired social function Psychotic delusions and hallucinations in mania and depression Bipolar Type II Milder form Mood swings from mild depression to hypomania No psychosis No impairment of social functioning Cyclothymia Type II mood swings that last for 2 years or more 14

15 Mixed Bipolar Disorder Some manic and depressive symptoms Simultaneously Quick succession Extremely disruptive Rapid-Cycling Bipolar Disorder Very severe 4 + cycles each year Signs and Symptoms Manic phase: Heightened energy, elation Irritability Racing thoughts Increased sex drive Decreased inhibitions Unrealistic, grandiose ideas Poor judgment Depressive phase: Signs and symptoms of major depressive disorder Treatment for Bipolar Disorders Requires mix of medications to address both mania and depression One without the other can trigger an episode Drugs may have unpleasant side effects, bad interactions with other medication Mood-stabilizing drugs based on lithium, plus antidepressants Medications Mood stabilizers For mania Lithium, lithium analogues Can be toxic Antidepressants For depression Anticonvulsants For mania Antipsychotics For hallucinations, delusions 15

16 Massage Therapy Implications Risks: Two issues Side effects of medications may make the client feel lethargic, irritable; The client-therapist relationship must be carefully tended Benefits: People with bipolar disorders need to maintain healthy social relationships. Conceivably massage therapy could be one path toward doing that. WHAT WE CAN DO Educated, welcomed touch is good for our mental and physical health Take advantage of the bio-psycho-social aspects of what we do: Bio = physical function Psycho = mood, mind, awareness Social = connections with others Who else has the potential for this much positive impact? What does touch do? (We don t actually know lots of theories, though) A lot has to do with the client s perception of safety and good will We can use some of that to make ourselves even more effective The Value of Ritual (From Fabrizio Benedetti) Part of our response to a treatment is the ritual that accompanies it ( hidden injections have less effect than open injections ) Expectations of results leads to results (good or bad) We can be conditioned to a positive response What can we do to use that information? Cognitive Behavioral Approach (From Alison Sim) CBT looks at the role of thoughts in how they modulate emotions and behavior It is collaborative (we re working together) Goals: Identify unhelpful thoughts Analyze them for accuracy Replace them with different thoughts 16

17 Scope of practice! Develop your skills: CB approach, not therapy Keep conversations focused on the issue at hand Refer out as necessary Build your network Recognize possible emergencies Use measures to track progress Create or join a peer supervision group CBT resources Free downloads for patients Thought record sheet n-us.pdf Motivational Interviewing (From Bronnie Lennox) Guide me to be a patient companion, to listen with a heart as open as the sky What is your main concern today? What would it be like if your situation were different? What do can you do for fun? Ask open questions, then Affirm Reflect Summarize Mental Health First Aid Thank You 17

Νευροφυσιολογία και Αισθήσεις

Biomedical Imaging & Applied Optics University of Cyprus Νευροφυσιολογία και Αισθήσεις Διάλεξη 19 Ψυχασθένειες (Mental Illness) Introduction Neurology Branch of medicine concerned with the diagnosis and