The psychotherapies indicated to diminish the stressrelated illness in children

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1 The psychotherapies indicated to diminish the stressrelated illness in children PANÃ (CUÞOV) MIHAELA 1 ABSTRACT: The biological, psychological and social consequences of the illness creates a veritable stress, named the stress-related illness. The concept of stress is defined as an organism s holistic response to environmental demands or pressures. A stress-related disease is a consequence of the excessive and prolonged demands on an organism s coping resources. Now, scientists believe that 80-90% of all diseases are stress-related. The treatment of stress-related illness includes: medication (such as drugs to control blood pressure or tranquilizers, antidepressants), stress management programs, behavioral approaches (relaxation techniques, breathing exercises, and physical programs including walking), massage, cognitive therapy, religious practices (new researchers have revealed positive correlations between these practices and stress level), and alternative treatment (like aromatherapy, dance therapy, biofeedback, dietary guidelines, nutritional supplements, acupuncture, homeopathy, and herbal medicine). In this paper, we present a few treatment of the stress-related illness: the cognitive- behavioral psychotherapy (CBT), relaxation psychotherapies, child and parents therapy support. Key words: stress-related illness, children, cognitivebehavioral psychotherapy, relaxation psychotherapies, child and parents therapy support. REZUMAT: Consecinþele biologice, psihologice ºi sociale ale maladiilor creeazã un veritabil stres asociat bolilor respective. Stresul este definit ca un rãspuns holistic al organismului generat de cererile ºi presiunile mediului. Stresul asociat bolii este o consecinþã a solicitãrii excesive ºi prelungite a resurselor de coping ale organismului. În prezent, cercetãtorii cred cã 80-90% din totalitatea maladiilor sunt asociate stresului. Tratamentul stresului corelat bolilor include: medicaþie (antihipertensive, tranchilizant, antidepresive), programe de management al stresului, abordãri comportamentale (tehnici de relaxare, exerciþii de respiraþie ºi exerciþii fizice care includ ºi mersul), masajul, practicile religioase (noi cercetãri ai revelat corelaþii pozitive între aceste practici ºi remedierea stresului) ºi tratamentul alternativ (aromoterapie, terapie prin dans, biofeedback, ghidare nutriþionistã, suplimente alimentare, acupuncturã, homeopatie ºi fitoterapie). În acest articol, prezentãm câteva tratamente ale stresului asociat bolilor la copii: psihoterapia cognitiv-comportamentalã, psihoterapiile de relaxare, terapia suportivã a copilului ºi a pãrinþilor. Cuvinte cheie: stres asociat bolilor, copii, psihoterapia cognitiv- comportamentalã, psihoterapii de relaxare, terapia suportivã a copilului ºi a pãrinþilor. DEFINITION OF STRESS-RELATED ILLNESS The bio-psycho-social consequences of an illness create a real stress. The concept of stress is defined as an organism s holistic response to environmental demands or pressures. The environment is perceived as straining or exceeding the adaptive capacities and threatening the well-being of persons. The differences in the way stress is perceived indicate that human stress responses reflect diversity in personality, in physical strength or holistic health. CAUSES AND SYMPTOMS Stress-related disease is a consequence of the excessive and prolonged demands on an organism s coping resources. Now, scientists believe that 80-90% of all diseases are stress-related. Recent research has indicated that some vulnerability to stress is genetic. Researchers at the University of Wisconsin and King s College London revealed that people who inherited a short, or stress-sensitive, version of the serotonin transporter gene were almost three times as likely to have depression following a stressful event than persons with the long version of the gene. Further research has been conducted to discover other genes that affect susceptibility to stress. 1 MD, PhD, Psychologist, Assistant Professor in Medical Psychology Department, University of Medicine and Pharmacy Carol Davila, Bucharest. 22 VOLUME 6, NUMBERS 3-4, DECEMBER 2012

2 THE PSYCHOTHERAPIES INDICATED TO DIMINISH THE STRESS-RELATED ILLNESS IN CHILDREN The symptoms of stress can be either physical or psychological. Stress-related physical illnesses, such as, heart attacks, arthritis, and chronic headaches, are a consequence of long-term overstimulation of a part of the nervous system that regulates the heart rate, blood pressure, and digestive system. Stress-related emotional illness is generated by inadequate or inappropriate responses to changes in one s life, such as illness, marriage, completing one s education, losing a job, etc. TREATMENT OF THE STRESS-RELATED ILLNESS Recent advances in the study of the many complex and interesting connections between the human mind and body have produced a variety of approaches to stress-related illness. Present treatments include one or more of the following: Medication. Use of medicine to control blood pressure or other physical symptoms of stress, as well as drugs that affect the patient s mood (tranquilizers or antidepressants). Stress management programs. These may be either individual or group treatments, and usually involve analysis of the stressors in the patient s life Behavioral approaches. These strategies include relaxation techniques, breathing exercises, and physical programs including walking. Massage. Therapeutic massage relieves stress by relaxing the large groups of muscles in the back, neck, arms, and legs. Cognitive therapy. These approaches teach patients to reframe the stressors in their lives in order to modify the body s physical reactions. Religious practices. New researchers have revealed positive correlations between these practices and stress level. ALTERNATIVE TREATMENT Treatment of stress is one area in which the boundaries between traditional and alternative therapies have changed in recent years, in part because some forms of physical exercise that were once associated with the counterculture have become widely accepted as useful parts of mainstream programs. Other alternative therapies for stress that are occasionally recommended by mainstream medicine include aromatherapy, dance therapy, biofeedback, nutrition-based treatments (including dietary guidelines and nutritional supplements), acupuncture, homeopathy, and herbal medicine (Dorland's Medical Dictionary for Health Consumers, 2007). In this article, we present the treatment of stress-related illness in children through psychotherapy. A comprehensive definition presents psychotherapy as a form of psychological treatment structured in techniques and methods, applied deliberately in group or individualized, by a specialized therapist, to a healthy person in difficulty, to whom it gives moral comfort, a better health and which helps to a better integration; the one with bonding difficulties; the one somatic suffering whom leads him to alleviation (Dafinoiu, 2001) Classification of the psychotherapies: Psychoanalytical Cognitive-behavior Experimental Non verbal (art therapy, music therapy, breathing exercises, etc.) Relaxation Hypnosis Bio-feedback Group psychotherapy Medical conversation to the patient (gesprachterapie), or with the client (non-directive therapy C. Rogers) (Iamandescu, 2002). Common goals for psychotherapies: Getting the patient out of the crisis. Reducing or eliminating the factual symptoms. Strengthening the self and patient s personality. Solving and reducing patient s intra psychical conflicts Reducing the environmental conditions that produce or sustain non adapting behavior. Modifying opinions, beliefs, misconceptions, dysfunctional perceptions about the surrounding world and about oneself. Obtaining a more mature functioning and a more flexible adaptation to the surroundings. Providing patients with instruments necessary to successfully face the future stressing situations. (Holdevici, 1996) The common factors in psychotherapies are: The interpersonal relationship of trust and warmth Reassurance and support Desensitization Strengthening the adaptive responses Understanding / insight (Atkinson R.L. & Atkinson R.C., 2002). VOLUME 6, NUMBERS 3-4, DECEMBER

3 PANÃ (CUÞOV) MIHAELA CONCLUSIONS In any type of psychotherapy the therapistpatient RELATION is important for the therapeutic outcome (for example, the studies conducted in the field of psychotherapy, have indicated that 30% of the success of therapies is related to the therapeutic relationship, 40% was granted to the patient resources, 15% to Placebo effect, and only 15% to the therapy`s techniques). (Norton, 1997, APA, 1999). The therapist must treat the sick PERSON, not just the disease per se. The human being is a complex bio-psycho-social-spiritual system, and there is a fluid interdependence between these dimensions. COGNITIVE-BEHAVIORAL PSYCHOTHERAPY (CBT) The conceptual frame of cognitive-behavioral therapies has three fundamental concepts: 1. cognitive activity influences the behavior; 2. cognitive activity can be monitored and modified; 3. the expected change in behavior can be facilitated by cognitive change (Dobson K, 2000). Development and effectiveness of CBT Currently behavioral cognitive-therapy is very well represented in both the U.S. and Western Europe, and is considered by most authors to be the most effective form of psychotherapy. Cognitive-behavioral therapy postulates the idea that there is an intrinsic connection between our mode of thinking, behaviors and emotions. Distorted and negative thoughts generate dysfunctions at the emotional and behavioral level. In the context of this therapy the cognitive restructuration ameliorates the emotional states and behavior. At the end of therapy, the patient will achieve the desirable behaviors and positive thoughts and emotions. Ellis elaborated an operational model ABC model which contains: Component A the extern activating event ( the doctor isn`t answering the phone ) Component B automatic negative thoughts ( he is sure that the analyses are bad and he is avoiding me ) Component C behavioral and emotional consequences (sadness, anxiety, anger, avoiding future contact of the doctor). The patient is encouraged to acknowledge these relations between the negative automatic thoughts and emotional, behavioral response. The second stage consists in breaking this vicious circle through different specific techniques. The techniques used for this form of psychotherapy are: oral Instructions; identification of negative thoughts and replacement with other alternative thoughts; determination and modification of cognitive distortions; the systematic desensitization in the imaginative plan and in vivo ; repetition technique (training); role play; shaping. The goal of this therapy is to increase the autonomy of the patient, optimizing the quality of life and improving the adaptability to the environment. The principles of CBT 1. The purpose of psychotherapy is to help patients to identify what their difficulties are and not what they are not. 2. The patient must be aware of the fact that his/her symptoms are real, and the treatment is necessary to create an explanation for their presence. 3. The psychotherapy sessions must not be some combative debate ( you do not have that disease ). The preferable methods are questioning and collaborating with the patient. 4. The patient s beliefs are produced by self-observed facts that are considered conclusive by the patient. Instead of disputing the patient beliefs, the therapist should find those facts considered evidences by the patient evidences for his/her illness, and then, discus and work upon those beliefs with the patient. 5. Both the patient and the therapist are to decide a short term contract that must comply with the therapist s requests and also with patient s anxieties. 6. Selective attention and patient s suggestibility must be used for demonstrating that anxiety is created by conjunctural factors, various symptoms and varied information. 7. It is necessary to verify the patient s level of understanding the information suggested by the psy- 24 VOLUME 6, NUMBERS 3-4, DECEMBER 2012

4 THE PSYCHOTHERAPIES INDICATED TO DIMINISH THE STRESS-RELATED ILLNESS IN CHILDREN chotherapist by proposing to the client to synthesize the received information and their outcome (Holdevici, I., 2000). RELAXATION PSYCHOTHERAPIES The other treatment of stress-related illness is relaxation psychotherapies like hypnosis, autogenic training, etc. Relaxation is a psychotherapeutic and self formative, scientifically grounded technique whose purpose is muscular and nervous alleviation, having as a result a more efficient repose, saving physical and psychical energy, the growth of body s resistance to stress, and minimizing the negative effects of already installed stress. ( Holdevici, 2001). One of the most well-known relaxation techniques is autogenic training Schultz. This training s effects are: better relaxation, decreased anxiety, more resting sleep, better capacity of concentration and a better memory. These advantages are also found in the psychotherapy of neurosis and psychosomatic diseases. If hypnosis is approached from the outlook of induction and deepening of trance, then it is not very different from other therapeutic techniques: autogenic training, progressive relaxation, guided imagery or bio-feedback based procedures (Holdevici, 2001). These techniques induce deep relaxation to the subject. In this state, attention is focused on sensations, emotions and inside images, while the patient is guided by relaxation suggestions and by ways of deepening the relaxation. The person is suggested to develop a non-analytical, passive attitude. Hypnosis emphasizes verbal suggestions, and images that induce modifications into the conscience state. This therapeutic technique is capable of growing psychotherapy s efficacy, because it increases patient s suggestibility, unblocks the imaginative resources, optimizes the therapist-patient relationship and reduces subject s orientation over reality (ibidem). Children are more prone to hypnosis than adults, concludes one study made on 1232 people aged The highest level of hypnosis was identified in children aged 9-12, and then it decreases with aging. Another factor that differences the level of hypnosis is gender (women are more prone to get hypnotized than men). Some researchers argue with these remarks. Optimizing the general evolution of illness, hypnosis can decrease anxiety, increase the self esteem of the patient.( Maher-Loughna GP et al. 1962) The therapist must take great care not to use direct suggestions. CHILD AND PARENTS THERAPY SUPPORT For a better understanding of the concept of therapy support, we will make a reference to prior, acknowledged definitions. I.B.Iamandescu considers that therapy support consists in a perpetual encouragement of the patient in parallel with the patient s emotional releasing, capable of diminishing anxiety, and it must also ensure all the necessary conditions for an efficient treatment. As we can see, the main elements in the definition are encouragement, catharsis, the reduction of anxiety, and the growth of therapeutic compliance.if the parents are involved in the therapy, both them and the child are to benefit from the same elements of therapy support. In this case, the therapy will have more beneficiaries, and so the therapy value will increase. (Cuþov- PanãM. 2008) Main objectives of support therapy: preventing or diminishing recurrent symptoms, increasing self-esteem, intensifying therapeutic compliance, good usage of adaptation resources and coping mechanism of the patient. Other objectives of this therapy are to decrease the maladapted behaviors, to mitigate anxiety and sadness caused by an illness. Wolberg (apud Iamandescu, 2002) asserted that the finality of psychotherapy support is: strengthening the existing defense mechanisms, and the rebuild of adaptive mechanisms. Using the adequate psychotherapeutic means, necessary to accomplish the above-mentioned objective, in the case of children, addresses a bio-psycho-social matter. The techniques and means used by the psychotherapist to reach these objectives are: active listening, suggestion, encouragement, education, making the patient understand the negative influence of a dysfunctional, harmful behavior from the past on one s health and help the patient change these attitudes. The purpose of teaching the patient is to develop some positive skills and attitudes in one s daily behavior. Within the support parental therapy, according to the child s age, there are several ways (Marcelli D, 2003): The same therapist for child and parents; Different therapists; Conversations with the parents in the presence of the child; Conversations with the parents in the absence of the child; Therefore, the little child (under 5-6 years) will be counseled preferably, together with the parent by the same therapist. The situation is different for teenagers; there can be common meetings parents-teenagers-therapists if the teenager agrees to it, but it is prescribed that the therapist VOLUME 6, NUMBERS 3-4, DECEMBER

5 PANÃ (CUÞOV) MIHAELA never see the parents in the absence of the teenager. The explanation for this different approach regards the psychoemotional particularities of the teen period. The biological and mental changes make them unstable, irascible, expecting confidence and trust from the therapist. Thenceforth we will expose the motivations of choosing a support therapy for the child and the parent. It is important to assess and treat the child, respecting the social and familial background. His psycho-emotional, economical dependence confirms the necessity to install a support therapy for the child and the parents. If this challenge cannot be transferred in reality, the practice certifies a rapid decay of the improvement made in the individual psychotherapy of the child. Brought up in the disturbed social and familial background, the child doesn t have the ability to maintain the cognitive, emotional and acting benefits during the therapy. The same version is also valid for the medical therapy of the child, if the family is not involved regarding the treatment administered to the child, his health will be compromised, even if the doctor is competent and medication is correct. An explanation for this difficult situation, consists in the level of the biological and psychological development of the child, which limits his perception, mind, action, attitudes, etc. Another factor, as we mentioned before, is his bio-psycho-social link with the family. Separated by the familial background, or a proper social support, the child has major survival difficulties. Therefore, the connections between the members of the family, even if distorted, are vital for the child. Although he was badly treated, physically and emotionally, nowadays children care institutions are inclined to maintain the child in the middle of his family, furnishing economical, psychological and social aid to the child s family. The very important function of the family in the child s development is a proof of the advantages of support therapy. In order to emphasize the brilliant roll of the implication of the parents in child s therapy, we will mention a famous psychotherapist, with yearlong practice in the infant area. Winnicot (apud Marcelli, 2003) claimed: Therapeutic examination won t bring any benefit if the child return in an abnormal family or an abnormal social situation. Hence, the social and familial background has a crucial mark in the appreciative evolution of the child s therapy. If the support therapy addressed to the family can improve the distorted family relations and the wellness of the child, the negative background can be changed in a positive one through the implication of the social assistance and of the competent authorities in this field. We emphasize this way on the importance of the multidisciplinary intervention in the child s approach. Thereby, the medical assistance, psychological and social, will be harmonious linked to the individual needs of the child, treated in his family social background. The function of the support parental therapy is to lead to therapeutic compliance to the treatment, to facilitate an improvement of the family relations and to decline the difficulties related to the child. This type of therapy doesn t have as an objective the changing of the family neurotic balance. The benefits of the parent s implication consist in the decrease of the guilt that the parent feels towards the child s situation, the exteriorization of the prospects, of the anxiety related to the child s. If the parent is not implicated in the therapy, he can create, conscious or not, several antagonisms attitudes ( What does the therapist say...i know better the child and I think I should do like this! ). A cause of this antagonistic attitude is the temporary loss of the therapist authority role. For the puissant parents who carry out only parental statute (without other social and professional functions), this event can be a source of anxiety. Often, in support therapy, parents ask for guidance and advice from the therapist. The experience of the children therapists from La Miletrie Hospital, Poitiers, attests the fact that complex advice induces a contradictory attitude in the parents; they can forget the advice, or they can follow it, but distorting its sense. Another attitude is the statement of the parent about the inefficacy of the guidance ( We did everything you said and look: there is no improvement, it s useless... ).It is all about a little game of the power and antipower between the parents and the therapist. It is important that the advice, the disclosures given to the parent, to be done at the proper time and in a delicate manner, so as not to increase the parent s anxiety and to create a distorted therapeutic relation. In order to obtain a successful therapeutic tie-up, it is preferable to offer the necessary information to the parents, to make them your ally. You can guide the parents so that they change possibly improper attitudes, making use of the proper language and moment. One of the support therapy limits consists of the family dynamic, deeply distorted and the major physical difficulties of the child or the parent. In these cases long-term therapeutic interventions are recommended, as well as cognitive therapies, and dynamic and systemic psychotherapies. CONCLUSIONS The best psychotherapies in stress-related illness in children are: cognitive-behavioral psychotherapy (CBT), relaxation psychotherapies and child and parents therapy 26 VOLUME 6, NUMBERS 3-4, DECEMBER 2012

6 THE PSYCHOTHERAPIES INDICATED TO DIMINISH THE STRESS-RELATED ILLNESS IN CHILDREN support. The therapist could also suggest to the patient a spiritual practice that could potentiate a good general health. REFERENCES 1. Atkinson R.L, Atkinson R.C. (2002) - Introducere în psihologie, p Ed. Tehnica, Bucureºti. 2. Cuþov (Panã) M. (2008) Psihologie Medicalã in Psihosomaticã Generalã ºi Aplicatã, coordonat de Prof. I.B. Iamandescu. Ed. Info Medica Bucureºti. 3. Dafinoiu, I. (2001) Elemente de psihoterapie integrativã. Editura Polirom Iaºi. 4. Dobson K. (2000) - Handbook of Cognitive- Behavioral Therapies, 2/e, Guidford Press, New York. 5. Dorland s Medical Dictionary for Health Consumers by Saunders, an imprint of Elsevier, Inc. 6. Escape from Babel (Norton, 1997); 7. Holdevici, I. (2009) Hipnoza Clinicã. Editura Trei, Bucureºti. 8. Holdevici, I. (2000) Ameliorarea performanþelor individuale prin tehnici de psihoterapie. Editura Orizonturi, Bucureºti. 9. Holdevici, I. (2001) Hipnoza clinicã. Editura Ceres, Bucureºti. 10. Iamandescu I.B., Luban-Plozza B. (2002) Elemente de psihoterapie în Dimensiunea psihosocialã a practicii medicale, p Ed. Infomedica, Bucureºti. 11. Maher-Loughna GP et al. (1962) Controlled trial of hypnosis in the symptomatic treatment of asthma. British Medical Journal, (2): Marcelli D. (2003) - Tratat de psihopatologia copilului. Ed. Fundaþiei Generaþia, Bucureºti. 13. The Heart & Soul of Change (APA, 1999). VOLUME 6, NUMBERS 3-4, DECEMBER