Stress Management Music, Imagery Herbal Therapy

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Stress ManagementMusic, ImageryHerbal Therapy
TAX TIME STRESS TIME

• NRSG 809
• MODULE 10

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Why is this important?

• 60-90 of health visits are for stress-related
  disorders
• Cost to economy gt 150 billion/year
• Personal costs?

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Demand Response

• Demands in communication
• Demands in action
• Stress response involves all body systems
• Coping strategies moderate response

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Communication Demands
Stress Response
Outcome
Action Demands

• Coping Strategies
• Appraisal threat vs challenge
• Perceived controllability
• Intensity duration of stressors
• Emotional behavioral skills
• Availability of social support

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Stress Management Strategies Pender et al.,
2002

• frequency of stressful situations
• Change environment, time management
• resistance to stress
• Exercise, self-esteem, assertiveness
• Countercondition to physio arousal
• Trade tension for relaxation

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Stress Management

• Relaxation Therapy, 20-30 min. daily
• Quiet space, comfortable position, receptive
  attitude, focus of attention (Benson, 1975, The
  Relaxation Response)
• Meditation -- mindfulness
• Relax body, still mind, connectedness opposite
  of over-arousal
• Focused attention on a word, sound, image,
  sensation for sustained time
• Non-judgmental attitude re intrusive thoughts

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Progressive Muscle Relaxation

• Thought muscle activity
• Tension is process to embody emotions
• To relax mind/body, skeletal muscles must be
  relaxed
• Original PMR model didnt use muscle tensing
• Later, changed to include tense/release cycle
• Sometimes, imagery also used

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Body Scan Meditation

• Recline, eyes closed, even breathing
• Relax feet, feel warmth relax ankles, feel
  warmth
• Continue around body
• Finish body scan with attention to neck and head
• Experience warmth of relaxation
• Fontaine (2000) Healing Practices

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Relaxation Outcomes

• PMR depression, anxiety
• PMR NK cell count, stress in elders
• PMR music cardiac complications after
  acute MI
• PMR meditation anxiety with cardiac
  cath
• Meditation self-esteem in 10th graders

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Imagery

• Ancient healing approach belief, hope, trust
• Perception of a stimulus in the absence of that
  stimulus
• Imagining then tasting a lemon
• Practitioners suggestions influences response
• Hand in ice water with 3 suggestions good, bad,
  neutral
• Expectations of illness, pain, healing

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Outcomes of Imagery

• skin temperature
• or heart rate depending on image
• BP with fear, anger images
• Used in athletics to performance
• pain during CA treatment
• anxiety during MRI
• pain after surgery
• NK cell activity

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Using Imagery

• Relax before imagery identify imagery goal
• Relaxation, stress reduction
• Active visualization of desired outcomes
• End with image of desired state (healed wound)
• Receptive visualization to learn about symptoms
• Guide helps awareness of image pt has re sx
• Why its there, what it wants, what it offers

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Imagery in Procedures

• Identify sensory features of procedure
• Assess pts perception of procedure
• Use words meaningful for pt
• Use synonyms discomfort vs pain
• Use specific examples
• Help reframe negative imagery
• Plan strategies for each step of test
• distraction, muscle relaxation, deep breathing

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Humor Therapy

• whatever one does to
• put mirth into a patient
• encounter Patch Adams, MD
• Laughter Myths (and realities)
• Must have a reason to laugh (need no reason)
• We laugh because were happy (happy laugh)
• Sense of humor laughter (sense of humor is
  learned, laughter is innate they arent equal)

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Humor Types Dossey, 2000, Holistic Nursing

• Hoping Humor courage to face challenges
• warm, gentle, laughter in spite of loss
• Billboard after 1997 floods in Midwest Concerned
  about the weather?
• Call 1-800-NOAH
• Coping Humor release for tension
• form of expressing hostility
• Gallows Humor protection from pain
• Transform situation into something amusing, e.g.,
  in ER, OR

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What Humor Provides

• Feeling of power in a difficult situation
• Less susceptible to depression
• Sense of perspective
• Opportunity for emotional release

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What Laughter Provides

• NK cell activity
• number of activated T cells
• salivary IgA level
• gamma interferon levels
• complement 3 levels
• Lower levels of stress hormones, e.g.,
  epinephrine, cortisol
• Stress Antidote

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Music

• Rhythm (intervals of time) melody (pitch, sound
  vibrations/sec)
• Greek mythology
• Apollo, god of music poetry, healer
• Asclepius, son of Apollo, god of healing, symbol
  of snake staff
• Believed music had power to heal body soul
• Ancient art used to express emotions, in
  ceremony, ritual

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Music Selections

• Individual choice
• Without words
• Iso-principle
• Matching mood to appropriate music
• Entrainment
• After matching initial mood, moving to more
  positive mood

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Responses to Music

• Soothing music relaxation
• Less stress anxiety in
• Healthy adults hospital employees
• Pts on mechanical ventilation
• Pts with CA
• Less pain in
• Pediatric burn pts
• Abdominal surgery pts
• Pts with RA

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Using Music in ICUJohnston Rohaly-Davis, 1996,
Crit Care Nsg Qtly, 18, 54-60

• Assess baseline anxiety, pain, etc.
• Assess personal interest, preference
• Quiet, uninterupted environment
• 20-30 min. BID
• Evaluate subj obj response

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Herbal Therapy

• Whole or parts of plants
• Used for gt 60,000 years
• Used by 80 of world population
• Chinese documented gt 7,000 herbs
• Herbs classified as dietary supplements in US, no
  specific medical claims, not approved by FDA

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Herbs Drugs

• 25 of US prescription drugs derived from plants
• Indian snakeroot reserpine
• Foxglove digoxin
• Peruvian bark quinine
• Willow tree bark aspirin
• Deadly nightshade atropine
• Opium poppy morphine

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Commission E

• expert committee established in 1978 by German
  government to evaluate safety efficacy of gt 300
  herbs
• complete guide published in English in 1998
• quick reference

http//libux.utmb.edu/comme/index.html
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Herbal Preparations

• Extracts
• Press herbs, soak in liquid, evaporate
  concentrated extract
• Infusion
• Steep plant parts in hot water, strain liquid
  can be drunk (tea)
• Poultice
• Mix dried herbs with water
  paste applied to skin

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Echinacea, purple coneflowerPhoto
http//springhillnursery.com

• Supportive therapy for colds, flu, chronic resp.
  infect., chronic wounds
• Phagocytocis stimulated by 20-40
• 16 trials, n3396 positive findings for
  preventing treating common cold

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Ginkgo biloba

• Peripheral vascular disease, cerebral
  insufficiency (memory loss)
• Macular degeneration 1 trial, n20 equivocal
  findings
• Dementia dozens of trials generally supportive,
  but poor methods require more research

• Photo http//www.altnature.com/gallery/index.htm
  l

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St. Johns wort

• Mild-to-moderate depression, anxiety
• Depression 27 trials, n2291 gt effective than
  placebo for short-term treatment
• 324 pts in RCT SJW vs imipramine same
  therapeutically, but SJW better tolerated

Photos http//www.altnature.com/gallery/index.htm
l
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American Botanical Council

• Clinical Guide to Herbs
• will be published summer 2002
• 2-page clinical overviews
• Patient information sheet
• Clinical research reviews
• www.herbalgram.org

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