Relaxation techniques for stress & pain management. Shelagh Wright PhD

Transcription

1 Relaxation techniques for stress & pain management Shelagh Wright PhD

2 Origin of term stress stress in the 17th century meant hardship, adversity, straits or affliction use of the term evolved in 18th century to denote force, pressure, strain or strong effort 1910: Sir William Osler assumed a causal relationship between hard work, stress and strain with his patients suffering from angina pectoris

3 Distress: Negative Stress Crushes Oppresses Unusual events carried beyond rational limits

4 Eustress: Positive Stress Motivates Excites Energizes

5 Psychological literature: three different approaches to stress An engineering, or stimulus based approach; A medicophysiological, or response based approach; A dynamic psychophysiological response, intervening between stimulus and response, mediated by cognitions (thoughts)

6 Engineering model of stress treats stress as a stimulus characteristic of the person s environment Stress is that which happens to a person (Symonds, 1947) viewed this way stress is a set of causes

7 Hans Selye s View of Stress Stress is the nonspecific response of the body to any demand placed upon it to adapt.

8 The General Adaptation Syndrome GAS (Selye, 1950s) stress: all of the non-specifically induced changes produced by a noxious agent response-based approach to stress: activation of two neuroendocrine systems: HPA: hypothalamic-pituitary-adrenal SAM: sympathetic-adrenal medullary Both under influence of hypothalamus

9 The nervous system (NS) central NS peripheral NS brain spinal cord somatic NS autonomic NS sympathetic NS parasympathetic NS increased heart rate decreased heart rate dilated airways decreased airflow inhibited digestion improved digestion constricted blood vessels dilation of blood vessels increased mental alertness mobilised fat and sugar increased ability of blood to clot increased sweating decreased saliva flow increased saliva flow secretion of adrenaline and noradrenaline (acute) cortisol (chronic)

10 Fight or flight response phrase coined by Walter Cannon (1914): A survival instinct to fight or run Biological purpose: to cope with physical stressors

11 Fight or flight response increased heart rate increased ventilation constriction of peripheral blood vessels/circulation increased serum glucose levels

12 Fight or flight response increased free fatty acid mobilization increased blood clotting increased muscular strength decreased gastric movement increased perspiration to cool body temperature

13 Anger and Fear two emotions associated with the stress response: anger fear anger produces the urge to fight fear promotes the urge to run and hide

14 General Adaptation Syndrome Stage 1 Alarm Reaction Stage 2 Resistance Stage 3 Exhaustion

15 General Adaptation Syndrome Exhaustion Stage physiological headaches, colds & flu psychological severe depression interpersonal end of relationships Inability to defend against stressors

16 Richard Lazarus View of Stress: A state of anxiety produced when events and responsibilities exceed a person s coping abilities.

17 Transactional model of Stress primarily concerned with cognitive evaluation and coping; Transaction implies a newly created level of interaction in which the separate person and environment elements are linked to form a new relational meaning.

18 Lazarus (1984) emphasis has changed from environmental stressors and responses to a consideration of personal perceptions of environmental events meaning an event has for a person, based on the person s feelings of threat, vulnerability and ability to cope

19 Stress is a process a person experiences a range of changing emotions; these feelings affect a person s behaviour; a person s behaviour impacts upon those around him or her.

20 Stress as a Process process is concerned with the flow of events; the environment and the person and his or her relationship with it are constantly changing; in primary appraisal a situation is perceived as either benign or a threat, challenging or harmful; secondary appraisal is concerned with the question of coping.

21 Coping as a process coping is what the person actually thinks and does in a stressful encounter and how these thoughts and actions change as the situation unfolds; coping is: context dependent; influenced by appraisals and resources; coping refers to efforts to manage, not the success of those efforts.

22 In problem focused coping the person: seeks information; tries to cope through problem solving strategies which may help to regain self control; attempts to change the situation.

23 Effective coping depends on resources related to health and energy; positive belief; problem solving skills; social skills; material resources.

24 Problem-focused coping includes problem-solving; decision making; information gathering; goal setting.

25 Problem-focused coping confers psychological benefits: increases self-esteem; increases sense of control; increases self-efficacy.

26 Emotion-focused coping: maladaptive Smoking; alcohol consumption; sickness absence; substance abuse.

27 Emotion-focused coping: maladaptive brings temporary relief; increases vulnerability to burn out; contributes to attrition rate.

28 Emotion-focused coping: adaptive stress control techniques; aimed at changing internal environment; change perception of stressor; increase sense of control and efficacy.

29 Complementary Therapies therapies which provide support; help to enhance overall well-being; may be used in conjunction with conventional medicine and nursing care

30 The Relaxation Response (Benson, 1974) Counteracts harmful effects of stress; Requirements: quiet environment (not essential) mental device passive attitude comfortable position (not essential)

31 The relaxation response promotes: decreased heart rate decreased rate of breathing slower brain waves

32 Purpose of Relaxation Techniques Deactivate the five senses body's sensory system Decrease stimuli and their associated perceptions Replace stimuli and perceptions with non-threatening sensations that promote the relaxation response

33 Diaphragmatic Breathing One of the easiest and most effective methods of relaxation Basically controlled deep breathing In yoga, this technique is called the pranayama

34 Steps to initiate diaphragmatic breathing Assume a comfortable position Concentration Visualization

35 Four phases of concentrated diaphragmatic breathing Phase I inspiration Phase II a very slight pause before exhaling Phase III exhalation Phase IV another slight pause after exhalation before the next inhalation is initiated

36 Rational underlying use of relaxation and imagery techniques: increase sense of control by providing techniques people can initiate for themselves; reduce feelings of helplessness and hopelessness; provide a calming diversion; break the pain-anxiety-tension cycle.

37 Empowerment through stress management Pressure or demand alteration of socio-political, economic and physical environment brain stress response coping behaviour outcome cognitive modification physiological modification behavioural modification selfhelp/professional intervention stress awareness

38 Autogenic Training Originated at beginning of 20th century from research on hypnosis by Schultz, a German neurologist; Aims to enable the person, through passive concentration, to revert from sympathetic activity to parasympathetic activity; Designed to reinforce the organism s natural tendency for homeostasis (Luthe & Schultz, 1969).

39 AT requirements 3 basic positions; Use of diary during trainee programme; Regular daily practice; Use of body scan prior to AT session; Use of cancelling technique after AT session; Support with lifestyle adjustments-ideally reduce alcohol, caffeine, increase exercise, healthy diet; quit smoking.

40 Autogenic Training Six standard exercises focus on body awareness of Limbs: Heaviness and warmth Heart and circulatory system Breathing Nervous system AT trainee learns to experience passive concentration

41 Physical activity Promotes excretion of anger hormones; Reduces feelings of anger; Promotes secretion of body s natural pain killers: endorphins; Enhances feel good factor; Enhances feelings of mastery, control; Improves health, well-being, strength & fitness; Converts negative energy to positive energy & use; Exercise bike is basic gym.

42 Cognitive-Behavioral Therapies Emphasis on self-management Share 4 common components Education; Skills acquisition; Cognitive and behavioral rehearsal; Generalization and maintenance.

43 Cognitive-behavioural techniques for relaxation progressive muscle relaxation, guided imagery, autogenic training, meditation, music therapy, breathing techniques, yoga

44 Impact of CBT/CT on QoL Increase sense of self-efficacy/mastery/coping; Reduce helplessness/hopelessness/ anxiety/distress; Promote relaxation response/ break pain-anxietytension cycle; Provide support; promote overall well-being; fulfil psychological need.

45 References Benson, H. (1975, 2000) The Relaxation Response. New York, Avon. Bird, J & Pinch,C (2002) Autogenic Therapy. Self-help for mind and body. Dublin, Newleaf Borysenko, J (1987) Minding the Body, Mending the Mind. New York, Bantam Carruthers, M. (1979). Autogenic Training. Journal of Psychosomatic Research, 23, Dewe, P, Leiter, M & Cox, T.(2000) Coping, Health and Organisations London, Taylor & Francis George, M. (1998) Learn to Relax: Easing Tension, Conquering Stress, Freeing the Self. London, Duncan Baird. Gregson, O. & Looker, T. (1996) The biological basis of stress management. In S. Palmer & W. Dryden (Eds), Stress Management and Counselling; Theory, Practice, Research & Methodology. London, Cassell. Kermani, K. (1996) Autogenic Training: The Effective Way to Better Health. London, Souvenir Press. Lazarus, R (2007) Stress and Emotion UK Springer Lazarus, R.S. & Folkman, S (1984) Stress Appraisal and Coping. New York, Springer. Linden, W. Autogenic Training; A Clinical Guide. London, Guilford O Hanlon, B. (1998) Stress: The Common Sense Approach. Dublin, New Leaf Rankin-Box, D (2001) The Nurses Handbook of Complementary Therapies 2 nd ed Balliere Tindall Rice, P. (1998) Stress and Health. Wadsworth Robertson, I (2005) Stay Sharp with the Mind Doctor.London, Vermillion. Selye, H. (1956) The Stress of Life. New York, McGraw-Hill.