Five Top Symptoms of Stress:

Transcription

1 Five Top Symptoms of Stress: irritability (42%) anxiety (39%) fatigue (37%) feeling sad (37%) low energy (35%)

2 Hypertension Silent killer needs to be listened to Consequences: heart, kidneys, brain Risk factors Family history Diet: sodium, alcohol, caffeine? Obesity/sedentary lifestyle Stress W J S i

3 From stress to heart disease Anxiety & hostility are risk factors, depression predicts recovery Elevated blood pressure (esp. w/ + fam. Hx) Testosterone, cortisol, and cholesterol Unhealthy behaviors (eating, drinking, smoking) Vagal tone/heart rate variability & inflammation Chronicity of anger (cynicism) Social consequences Connection to others (social support) Loneliness BP w/o cardiac output

4 Migraine headaches Risk factors Its your parents fault! Diet Drop in estrogen, progesterone, and HRT Treatment Medication: triptans, ergotomines, Beta-blockers, calcium channel blockers, anticonvulsants Diet Blood volume pulse biofeedback > skin or EMG BFK (Pain, 2007 meta-analysis)

5 Risk factors for tension headaches Female (chronic daily only) Frequency of stressors it is in the eye of the beholder Low pain threshold at baseline, Coping style: Avoid avoidance! Muscle Tension:

6 Best practices in tension headache management Medications Exercise/activity/stretching/yoga Ergonomics (avg. of % pain reduction) Relaxation: Superiority of meditation; the factor that matters Biofeedback

7 Evidence-Based Behavioral Medicine for musculo-skeletal back & neck pain Medication (TCAs/SSRIs, better w/ neuropathic pain) Visualization & biofeedback (focused attention) Acupuncture: effective short term for neck pain, one study for long-term benefit for LBP Massage & ergonomics: patient expectations & responsibility CBT & self-management (Kate Lorig & others)

8 Temporo-mandibular joint disorder Risk factors Parafunctions (aka not listening ) Disability Anxiety, passive interpersonal style Avoidant coping (e.g., alcohol) EBBM Mobilization/splints/massage Habit reversal (tooth contact) Biofeedback/stress management

9 Stress-related fatigue Lowering sleep duration & quality (sleep and rhinovirus; Cohen, 2009) Muscle fatigue from chronic armoring HPA activation & thyroid dysfunction Fibromyalgia and chronic fatigue syndrome

10 Mind over mood Requires awareness of mood Personalized rationale for increased awareness (aka why be more aware of my anxiety? ) Motivation for change ( ready, willing, and able )

11 How mental states affect the immune system Predictability and control Self-efficacy Positive emotional style (Cohen, 2006) Problem-focused v. emotion focused v. avoidant coping (flexible use of diverse strategies) Social support ( little help from my friends ) Mindfulness ( cortisol and NK activity in breast and prostate cancer, BBI, 2007 &2008)

12 Cognitive strategies: Tracking pain, medications, mood, and activity Problem-solving & scheduling Cognitive restructuring ( It s all grey! ) Diversity of coping strategies & on-going support What will you do for you and your patient?

13 Common cognitive distortions heard from patients with stress-related symptoms Shoulds /perfectionism Fallacy of fairness Fallacy of change Polarized thinking Magnification Over-generalization

14 Burnout & Emotional Fatigue Emotional exhaustion, cynicism, inefficacy, fatigue Top 20% of scores on burnout had 79 % increased risk of CAD (Toker, Psychosomatic Medicine, 2013) Job strain fit and role ambiguity v. intrinsic motivation High emotional demands X low decisional latitude Caregiver burden Depletion of personal investment Traumatic response Emotional numbing from prolonged re-experiencing, vigilance & hyperstartle

15 Chronic Fatigue and Stress Syndrome Metabolism of CFS patients is normal and symptoms are due to psychological factors, with mental fatigue considered a lack of motivation (the brain is major consumer of resting cellular energy!) Parental physical abuse, childhood GI symptoms, and parental reports of many colds each had ORs > 1.6 for patients with CFS. Outcomes are predicted by in perceived problems with activity and an in sense of control over fatigue. Patients with CFS tend to perceive problems with activity independent of their own objective performance and see CFS as uncontrollable, itself resulting in chronic anxiety and fatigue. When gluccocorticoids, adrenal stress-hormones, are released as part of short term stress they destroy weaker/older lymphocytes; prolonged stress leads to indiscriminate destruction of lymphocytes. Prolonged stress elevations and compromised compensatory recovery systems can result in autoimmunity.

16 Chronic Fatigue Immune Dysfunction CFS patients have less seasonal variation in symptoms than patients with depression. CFS patients also have subtle cognitive/information acquisition deficits (CNS changes?). Findings have consistently shown adrenal insufficiency/low cortisol especially during typical morning surge. CFS also have been shown to have low heart rate variability. Pro-inflammatory cytokines act on the brain to cause sickness behavior. When inflammation continues unabated, such as during systemic infections, cancer or autoimmune disorders, the ensuing immune signaling to the brain can lead to exacerbation of depression. This may be why depressive symptoms such as fatigue, reduced interest, and low mood is more prevalent with immune dysfunction.

17 Evidence-Based Behavioral Medicine, Chronic fatigue and Fibromyalgia Effective interventions Nutritional/pharmacological Antidepressants Anticonvulsants Behavioral Stretching, exercise ( HR variability?), yoga Pool-based exercise Balneotherapy (baths) Whole body vibration Acupuncture Self-management models (e.g., sleep hygiene)

18 Resilience Social competence Ability to select and pursue attainable goals Control over one s actions and emotions Understanding and connecting with other people (secure attachment) Hardiness (Kobasa) Sense of control Meaning to one s existence Viewing change as challenge Self-compassion, Self-complexity Positive emotionality Ambient positive emotions & ability to express them in the wake of adversity (granularity/ emotional vocabulary ladder) Confidence, Optimism, Finding meaning Bias toward problem-focused coping

19 Attributional style How we think about our problems Personal? Pervasive? Permanent? (internal.. external) (global. specific) (stable.. temporary)

20 Acceptance and Commitment Therapy Mindfulness: moments, self-awareness, healthy dissociation Acceptance: % unfixable, If I were more willing to be anxious, I may not be so anxious Values-based living What is important? Engaging in a meaningful life Listening to your body/self gives you power to choose action or acceptance