The Stressed Patient An Overview of the Progressive Muscular Relaxation Process A Presentation for S

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The Stressed PatientAn Overview of the
Progressive Muscular Relaxation ProcessA
Presentation for SOMC Medical Education

• Kendall L. Stewart, M.D.
• May 9, 2008

1I hope to offer practical insights that will
assist you in serving your stressed patients and
in reducing the stress in your life. 2Please let
me know whether I succeeded on your evaluation
forms.
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Why is this important?

• Many of your patients will complain about
  stress.1,2
• Many who are stressed will complain about
  something else.
• Most stressed patients are looking for a pill.
• They will usually be convinced that someone else
  is to blame.
• A few will take personal responsibility for their
  stress and seek your advice about how to manage
  it better.
• This presentation is for them.

• After this presentation, you will be able to
• Describe the extent of the problem with stress in
  our culture,
• Identify the most common causes of stress
• Conduct a practical exercise that will
  temporarily decrease the stress in life.
• For those rare patients who will practice this
  exercise regularly, this will become an valuable
  tool in their lifelong efforts to minimize the
  negative impact of stress on their lives.

1Many of these stressed patients will demand that
you declare them disabledparticularly as they
near retirement. 2A patient with
successfully-treated depression insisted on my
declaring her disabled when she became miserable
in her job.
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What is the impact of stress on our patients?

• Forty-three percent of all adults suffer adverse
  health effects from stress.
• Seventy-five to 90 of all doctor's office visits
  are for stress-related ailments and complaints.
• Stress can play a part in problems such as
  headaches, high blood pressure, heart problems,
  diabetes, skin conditions, asthma, or arthritis
  in addition to depression and anxiety.

• The Occupational Safety and Health Administration
  (OSHA) declared stress a hazard of the workplace.
  
• Stress costs American industry more than 300
  billion annually.
• The lifetime prevalence of an emotional disorder
  is more than 50, often due to chronic, untreated
  stress reactions.1

1Information provided by Jerome F. Kiffer, MA,
Department of Health Psychology and Applied
Psychophysiology, The Cleveland Clinic Foundation
on WebMD.com
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Why do patients complain that they are stressed?

• Its my job.
• Its my boss.
• Its my spouse.
• Its my kids.
• Its my family.
• Its money.
• Its this pain.
• Its the government.
• Its the insurance companies.
• Its the idiots on the road.
• Its not my fault.
• (But it always is.)1,2,3

1It is pointless to argue with patients who are
consumed with any strongly-held belief. 2A man
presented with the conviction that someone had
drugged him through his well water and stolen
country songs. 3A man believed that God had
turned a deer around so he could shoot it.
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What are the key steps in the progressive
relaxation process?1,2

• Explain the process.
• Obtain informed consent.
• Make it clear that the patient may end the
  process at any time.
• Assume a relaxed position.
• Close your eyes.
• Focus intently on tensing the relaxing specific
  muscle groups.
• Debrief afterwards.
• Consider making recording.
• Recommend weekly practice.

1 The relaxation response includes changes in
metabolism, heart rate, respiration, blood
pressure and brain chemistry. 2Let me illustrate
the process.
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Where can you learn more?1

• American Psychiatric Association, Diagnostic and
  Statistical Manual of Mental Disorders, Fourth
  Edition, Text Revision, 2000
• Department of Behavioural Neurosciences, McMaster
  University, PsychDirect Evidence Based Mental
  Health Education Information,
  http//www.psychdirect.com/anxiety/soc.html
• Goldman HH, Review of General Psychiatry, Fifth
  Edition, 2000
• Kaplan HI, Sadock BJ, Synopsis of Psychiatry,
  Tenth Edition, 2007
• Jacobson JL and Jacobson AM, Psychiatric Secrets,
  Second Edition, 2001
• Benson, H and Klipper, M, The Relaxation
  Response, Harper, 2000
• Stewart KL, Dealing With Anxiety A Practical
  Approach to Nervous Patients and an Overview of
  the Objectives in the Anxiety Module in the OUCOM
  Psychiatry Block, 2000

1Please visit www.KendallLStewartMD.com to
download related White Papers and presentations.
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How can you contact me?1
Kendall L. Stewart, M.D. VPMA and Chief Medical
Officer Southern Ohio Medical Center President
CEO The SOMC Medical Care Foundation, Inc. 1805
27th Street Waller Building Suite B01 Portsmouth,
Ohio 45662 740.356.8153 StewartK_at_somc.org
KendallLStewartMD_at_yahoo.com www.somc.org www.Kend
allLStewartMD.com
1All speaking and consultation fees benefit the
SOMC Endowment Fund.
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