MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'acceptance'. Sat, 03 Sep 2011 01:53:11 +0100 http://www.medworm.com/index.php?rid=5159895&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F23%2Fself-management-a-very-vexing-definition%2F Self management is one of those terms that is used to describe the aim of cognitive behavioural programmes for chronic pain. It’s even in my description of this blog! At the same time, it’s difficult to arrive at a definition of self management that “everyone” agrees upon. Self management can mean helping people to be “actively involved in their health care and to provide a variety of creative and individualized strategies to deal with their health problem in their daily life and ultimately to live as normally as possible despite their symptoms” (Zuffery & Schulz, 2009) – but the Devil is in the details! What exactly does being “actively involved” mean?  Can it mean accessing treatments like massage, injections, acupuncture &#8220... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5159895 Mon, 22 Aug 2011 19:21:38 +0100 5159895 http://www.medworm.com/index.php?rid=5107847&cid=t_105204_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2011%2F08%2F08%2Fon-the-loss-of-a-cancer-blogger-guest-post%2F Since I began this blog, I have always wrestled with the question of how to handle Guest Posts of survivors that are not doing well.  Early on I even considered whether or not to publish the names and URL’s of blogs of folks that have passed away.  Last Wednesday I offered the difficult post by Alli, who was struggling with the inevitable issue of quality vs quantity of the time left us when our disease rises up and begins to beat down our last defenses. Now that I am working in a bone marrow transplant clinic and proudly wear my leukemia and transplant badges in order to give my patients hope, the editorial conflict is more acute.  I frequently had out Being Cancer Network business cards to my patients. But after all Death is what we fear when we first heard our doctor say the wo... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=5107847 Mon, 08 Aug 2011 19:16:06 +0100 5107847 http://www.medworm.com/index.php?rid=5062519&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F25%2Fusing-the-chronic-pain-acceptance-questionnaire%2F Over the past few months I’ve been using the Chronic Pain Acceptance Questionnaire (CPAQ-8) as part of a battery of questionnaires used at intake and outcome measures.  Along with the CPAQ-8, we use the Tampa Scale for Kinesiophobia, the Depression Anxiety Stress Scale, the Pain Anxiety Symptoms Scale, the Pain  Catastrophising Scale, Pain Self Efficacy Questionnaire, and Pain Disability Index. The CPAQ-8 consists of two subscales: Pain Willingness and Activity Engagement.  Together they measure “acceptance” or psychological flexibility associated with chronic pain. Let me pull this apart a bit.  Pain Willingness refers to how prepared a person might be to experience an increase in pain so they can get something important done.  For example, I love to dance and I&#82... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5062519 Sun, 24 Jul 2011 19:15:16 +0100 5062519 http://www.medworm.com/index.php?rid=4968845&cid=t_105204_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2011%2F06%2F24%2Flets-beat-this-things-new-blog%2F This notice came to me in May – I think I was in hospital at the time.  Meg is a photographer and a breast cancer survivor.  She just started her blog last March.  I have excerpted a portion of a recent post for your edification. Last Wednesday, we celebrated Mike’s Uncle Johnny’s life at his funeral service and burial.  It was a very nice service and although the circumstances weren’t ideal, it was nice to see all of Mike’s family.  Unfortunately, coming from a pretty big family as well as marrying into a big family means that I have attended a lot of funerals in my twenty-nine years.  But, this time it was very different.  Sitting in the pew next to Mike at the gorgeous Shrine of the Little Flower Church, I was reminded of our amazing wedding day in t... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4968845 Fri, 24 Jun 2011 14:16:02 +0100 4968845 http://www.medworm.com/index.php?rid=4803558&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F10%2Fcatastrophising-and-maybe-what-to-do-about-it-for-subacutechronic-pain%2F This study is also an excellent one for looking at process, or how people change over time using a daily diary method. The finding in this paper suggests that one way for helping people be more resilient and modify their tendency towards catastrophising might be to help them identify and then pursue positive experiences during each day.  Scheduling pleasant or enjoyable events as part of a daily routine is certainly something any clinician can do, and often those pleasant events can be physical, such as going for a walk, playing with the kids, or even doing some stretches. Finally (but not the final word!), a study by McKnight and colleagues looked at the mediating effect of self efficacy on the relationship between catastrophising and disability.  In this study, participants with early ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4803558 Tue, 10 May 2011 02:18:40 +0100 4803558 http://www.medworm.com/index.php?rid=4704713&cid=t_105204_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F04%2F12%2F6-tips-for-living-with-an-autism-spectrum-disorder-in-college%2F As Autism Awareness month continues, April is a time of transition for many high school seniors, as they learn what colleges and universities they got into. So it seems like an ideal time to talk about autism and college, and some tips to help with the transition. The excerpt below is from the book, Living Well on the Spectrum by author Valerie L. Gaus, Ph.D. The book is a self-help book that helps a person with an autism spectrum disorder identify life goals and the steps needed to achieve them. Read on for the excerpt… April is the month when most high school seniors receive their college acceptance letters and begin to plan the next phase of their lives. The transition from high school to college can be very difficult for people on the spectrum. All too often I am referred a youn... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4704713 Tue, 12 Apr 2011 21:05:05 +0100 4704713 http://www.medworm.com/index.php?rid=4677137&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F05%2Fwhat-is-coping%2F When we use the word ‘coping’, what do we mean? Recently, I’ve been reviewing the whole concept of coping in chronic pain.  I’m trying to establish how people with chronic pain view this term, and what they include in their repertoire of ways to cope.  My research is looking at the ways that people who cope well with their pain, and never need input from a chronic pain management team, do so.  And in doing this research, I’m hitting some conceptual snags. The thing is, coping as a concept isn’t defined all that well.  Some definitions refer to the outcome of coping: “he coped well with that” meaning “he managed that stressor in a positive way and the outcome was good”; some definitions refer to the process of coping and don&#8... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4677137 Tue, 05 Apr 2011 06:55:06 +0100 4677137 http://www.medworm.com/index.php?rid=4664499&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F31%2Fmoodjuice%2F I had a nice email from James Hardie from Moodjuice website, an NHS Scotland site developed for both health professionals and individuals to access self help resources. For patients, the site starts by saying “Emotional problems are often the mind and body’s way of saying that something needs to be changed in our life” - I like that!  I like the way the patient area is based on practical problems like housing, childcare, hobbies and interests, meeting people, relationships and so on. For professionals, the feature that really appeals to me is the “build your own resource” area.  This enables you to put together the most relevant handouts for the person you’re seeing – a lovely feature! Then you can print the whole lot off, and it’s a pulled-tog... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4664499 Wed, 30 Mar 2011 20:12:26 +0100 4664499 http://www.medworm.com/index.php?rid=4653616&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F30%2Fwhat-do-people-expect-when-they-get-referred-to-a-pain-management-centre%2F This study also found that many people didn’t feel they had been heard, or taken seriously prior to being referred. Participants in their study “needed to feel legitimated in the sick role, and part of the reason for wanting to know the cause of the pain was a desire to seek legitimacy in the eyes of others.” They made an interesting observation in that participants ranked the statement “I would like to have a better understanding of my pain” fifth on the list of 10 statements, and in the focus group discussion, identified having a diagnostic label as something different from having a better understanding. Allcock, Elkan and Williams suggest that “It was not so much personal understanding of their pain that they needed to legitimise it, as a diagnostic l... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4653616 Tue, 29 Mar 2011 18:25:34 +0100 4653616 http://www.medworm.com/index.php?rid=4642938&cid=t_105204_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2011%2F03%2F28%2Fluck-and-cancer-guest-post%2F Reprinted from LUNGevity, a Linked-In group: What is Luck? March 17th, 2011 – by Jill Feldman I have a wonderful husband, loving children, supportive family, thoughtful friends, a roof over my head, food on the table, great health insurance (very important in my family), etc.   For all that, I consider myself to be very fortunate, but am I lucky? When it comes to lung cancer, people tell me all the time that I’m lucky. I’m lucky that my cancer was caught early, I’m lucky that I was able to have surgery, I’m lucky that I was armed with knowledge about lung cancer, I’m lucky that I had the lung cancer world at my disposal, etc.  Am I lucky?  What does it mean to be lucky? According to my mom it can be a chance happening, like winning the lottery.  Or she would say that i... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4642938 Mon, 28 Mar 2011 09:53:51 +0100 4642938 http://www.medworm.com/index.php?rid=4622515&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F23%2Fits-there-and-im-stuck-with-it-chronic-knee-pain-after-knee-joint-replacement%2F I share an office with an Emeritus Professor of Orthopaedic Surgery.  He snorted at me one day, and showed me the stats from our national joint register database where I saw that while the main reason given for revision of a total hip joint was dislocation, and pain was the sixth most common reason given; in the case of revision of knee joint replacements, persistent pain was the most common reason given. Some studies have shown between 6 – 30% of people receiving total knee joint replacements have ongoing pain months after their immediate post-surgical recovery.  With knee joint replacement such a common surgery for osteoarthritic knees, and some reports of up to 33% of the adult population having OA of the knee, that’s a lot of people who continue to have pain! It’s n... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4622515 Tue, 22 Mar 2011 18:22:40 +0100 4622515 http://www.medworm.com/index.php?rid=4610964&cid=t_105204_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2011%2F03%2F18%2Fcountdown-guest-post%2F I first planned to republish this selection last spring.  I saved it as a draft and somehow it got lost.  Kate was writing at Strong. Fighting. Surviving. When I rediscovered the post a few days ago, I went to her blogsite to notify her of my plans.  It was then that I discovered she had passed away last June.  Pancreatic cancer is a bitter aggressive disease.  Our blog list contains just eight blogs by  pancreatic survivors. Below the original selection I decided to republish both Kate’s last post, named with brace irony “Mundane”, as well as the announcement of her death with brings an end to a blogger’s story. Countdown I’ve been gone for a very long time, I know, and I’m sorry. Everyone has been so supportive during my hiatus – sending me emails,... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4610964 Fri, 18 Mar 2011 13:34:26 +0100 4610964 http://www.medworm.com/index.php?rid=4560606&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fthe-dark-side-of-goal-setting%2F .It’s worth bearing in mind the dark side of goal-setting so that you don’t stray from your overall aims. Goals can be useful, but they shouldn’t be too inflexible.Too specific: It’s easy to get stuck on a goal that’s too specific and lose sight of the overall aim. Goals should be in the service of our overall aims, they shouldn’t be our masters.Too many: when people have too many goals they tend to concentrate on the easy ones. If the difficult ones are more important, once again the overall aim can suffer.Too soon: short-term goals encourage short-term thinking. Do you want your business to be around in five, ten or twenty years? The reason it’s difficult to get a cab on a rainy day in New York is partly because cabbies do such good business that... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=4560606 Tue, 08 Mar 2011 19:18:32 +0100 4560606 http://www.medworm.com/index.php?rid=4532586&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F01%2Fan-occupational-view-of-the-christchurch-earthquake%2F The picture – what greeted us as we walked through the front door – and that sparkly stuff on the ground? It’s all my crystal in tiny sharp shards…The wooden thing you can see is the bottom of our sideboard, and to the far right, the doorway. It’s not often I post with a specific focus on ‘occupation’ as the occupational therapy profession defines it.  This is not, I hasten to add, because I don’t think it’s important, it’s more a case of my posts being about the processes that underlie effective engagement in ‘occupation’ for people with chronic pain. But today, in the aftermath of the horrific earthquake in Christchurch one week ago, I’m taking time to reflect on some aspects of the earthquake that people have... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4532586 Tue, 01 Mar 2011 00:34:39 +0100 4532586 http://www.medworm.com/index.php?rid=4522318&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F26%2Fearthquake-aftermath%2F Dear Readers I have had many, many expressions of concern since the earthquake struck Christchurch again on Tuesday 22 February 2011.  I’m glad to say that me and my family have escaped relatively unscathed from this traumatic event – I can’t say how badly hit my home city has been though.  While the earthquake on 4 September last year was certainly awful, this one has been so much more devastating in terms of the physical damage, not to mention the human cost in loss of life and both physical and emotional damage.  The infrastructure in Christchurch is incredibly damaged – I live in New Brighton, and we are expected to not have power for several weeks; we have no water or sewerage; the roading is terribly broken up with huge holes and smelly, sewage-contaminated... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4522318 Fri, 25 Feb 2011 21:52:26 +0100 4522318 http://www.medworm.com/index.php?rid=4477821&cid=t_105204_109_f&fid=35088&url=http%3A%2F%2Fqw88nb88.wordpress.com%2F2011%2F02%2F15%2Fbread-and-beauty%2F “If, of thy mortal goods, thou art bereft, And from thy slender store two loaves alone to thee are left, Sell one & from the dole, Buy Hyacinths to feed the soul” - Muslihuddin Sadi, 13th Century Persian Poet (Source: Andrea's Buzzing About:) Andrea's Buzzing About: blogs http://www.medworm.com/rss/comments.php?id=4477821 Tue, 15 Feb 2011 05:17:58 +0100 4477821 http://www.medworm.com/index.php?rid=4460196&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F11%2Ffriday-meditation%2F As you know, Friday is about getting ready for the weekend.  Today I decided not to pass on some of the horrendous puns shared with me by one of my esteemed colleagues (although I may drop just one in because I can!).  Instead I thought this poem is a chance to consider being ‘in the now’, something clinicians working in pain management really need. Salutation To The Dawn Look to this day! For it is life, the very life of life. In its brief course Lie all the verities and realities of your existence: The bliss of growth, The glory of action, The splendor of achievement, For yesterday is but a dream And tomorrow is just a vision, And today well lived makes every yesterday a dream of happiness And every tomorrow a vision of hope. Look well, therefore to this day! Such is th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4460196 Thu, 10 Feb 2011 21:04:50 +0100 4460196 http://www.medworm.com/index.php?rid=4455498&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F09%2Fmore-on-choosing-chronic-pain-questionnaires%2F Mood and anxiety - depression, anxiety and pain-specific anxiety were chosen because of their importance to outcomes, and the need to treat psychopathology Catastrophising – because this is thought to be one of the most important aspects of cognition that needs to be addressed Pain-related anxiety and avoidance – because this appears to be one of the strongest predictors of ongoing disability Acceptance – this domain has been emerging as an increasingly important treatment process variable, and may be a target for intervention Pain location and intensity - yes, we do ask, just in case you wondered! Pain self efficacy – again, this seems to be an important process variable, and a target for treatment.  It’s also associated with higher levels of disability. Pain-related disability... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4455498 Wed, 09 Feb 2011 08:56:40 +0100 4455498 http://www.medworm.com/index.php?rid=4446048&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F07%2Fchoosing-chronic-pain-questionnaires%2F Choosing a set of questionnaires for an assessment battery can be a task fraught with all kinds of traps, because if there is one thing bound to get clinical tongues flapping, it’s the idea that their favourite questionnaire will be left out of the mix! And to complicate matters for us Southern Hemispherians, most of the research into normative data for questionnaires is North American, so it can be a long, quite tedious and epic job to arrive at a set that covers all the basic domains, doesn’t give the client questionnaire-fatigue, and uses psychometrically-sound  instruments. At the Centre where I work, the set of questionnaires has just been reviewed and, working with a number of clinicians from around the country, we have arrived at a set that seems to be a reasonably work... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4446048 Mon, 07 Feb 2011 05:53:13 +0100 4446048 http://www.medworm.com/index.php?rid=4433137&cid=t_105204_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F02%2F03%2Fnegatively-oriented-therapy-takes-its-place%2F “Misery loves company and our company loves misery.” – I.M. Kidding, NOT founder “Hatred cannot coexist with loving-kindness, and dissipates if supplanted with thoughts based on loving-kindness.” – The Dhammapada In a recent issue of the Journal of Positive Psychology researchers Michael Cohn and Barbara Fredrickson were able to demonstrate the sustainability of positive experiences with subjects who had engaged in loving kindness meditation (LKM). This is the first time researchers from the field of positive psychology have demonstrated that an intervention designed to enhance subjects’ well-being produced sustainable results. Prior to this the positivity of any specific intervention was notable, but its enduring effects were unknown. The researchers were a... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4433137 Thu, 03 Feb 2011 11:00:14 +0100 4433137 http://www.medworm.com/index.php?rid=4429241&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F03%2Fcbt-approach-in-the-real-world%2F While there are many papers published about the outcomes from using a cognitive behavioural approach, there are very few describing the process ‘in the real world’. This leaves a gap for many clinicians who may read about it, maybe have training in delivering this type of intervention, or work in a team where it’s an integral part of practice – but who may not know how it ‘works’ except as it’s delivered in a pen-and-paper, sitting-in-a-clinic-room kind of way. Today I’m describing one way I go about integrating a CBT approach into my work.    This case study is a compilation of several people I’ve worked with, in order to protect patient privacy. Simone has neuropathic pain in her dominant hand. She’s a tough cookie who worked... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4429241 Wed, 02 Feb 2011 19:33:39 +0100 4429241 http://www.medworm.com/index.php?rid=4414656&cid=t_105204_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2011%2F01%2F29%2Fdisability-vanishes-overnight%2F Earlier in the week I was buying gas at the supermarket filling station in the middle of a large parking lot.  As I climbed back in my truck, I noticed a middle-aged man walking across the lot.  Actually “hobbling” would better describe his gait.  While his left foot seemed to proceed normally, he  “dragged” his right foot at right-angles behind him.  He wore a stylish light winter jacket, slanted woolen cap, striped scarf and glasses. For some reason I imagined that he was gainfully employed but possessed of some physical handicap, perhaps a cerebral palsy-type disorder.  Yet he seemed to be moving purposefully.  But the extra effort and concentration required to drag his affected limb was obvious.  I felt that he must be a stalwart individual, someone to b... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4414656 Sat, 29 Jan 2011 19:25:19 +0100 4414656 http://www.medworm.com/index.php?rid=4419468&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F30%2Foccupational-therapy-the-cognitive-behavioural-approach-for-pain-management%2F I have always resisted being labelled. I am much more than my gender, my marital status, my diagnosis, my professional background.  I also feel quite uncomfortable about being told what I may or may not do (maybe that’s where my kids get it from?!). I don’t like being told what is and isn’t ‘my role’ or someone else’s role.  I’m interested in what works and doing it well and at the right time for the right reason.  Today’s post is the first of a two-part commentary on a paper by Robinson, Kennedy and Harmon published in the American Journal of Occupational Therapy this month in which it is argued that occupational therapists who offer cognitive behavioural therapy ‘without sufficient attention to occupational therapy’s professi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4419468 Sat, 29 Jan 2011 19:00:53 +0100 4419468 http://www.medworm.com/index.php?rid=4399841&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F26%2Fpulling-it-all-together-biopsychosocial-assessment%2F Over the past little while I’ve been writing about how a comprehensive pain assessment can be carried out.  Today it’s time to pull that information together to develop a formulation, or set of possible explanations for why this person presents in this way at this time – at least for one or two aspects of his presentation. For example, if the person’s pain is low back pain, where surgery has failed to improve the person’s pain, but he has maintained working in a teaching job where physical demands are reasonably light, but is having trouble with sleep, feels irritable, can’t manage things like mowing lawns, and is very careful not to bend because he was advised after surgery to avoid bending because it may affect healing.   Limited forward flexion, si... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4399841 Wed, 26 Jan 2011 01:00:45 +0100 4399841 http://www.medworm.com/index.php?rid=4338220&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2011%2F01%2Funfinished-made-perfect.html Her very first journal entry ever read sad.It's fall 2010 and it's hard for me. My mother has cancer and my sister Amy has epilepsy. My brother Caleb is hard to take care of and Rosy is hard to please. September 28, 2010 I talked to her about finding the silver lining. About thankfulness as a choice. Encouraged her to add a few lines. In red, below the black pencil of pain, another sentence is added. The sentence that really breaks my heart.I'm thankful that my mother and Amy are still here. I have this idea in my head of who they are, these four children. I know this: they bear the image of God, they are full of creativity, passion, justice, beauty. And they live in a broken world, and side by side with the characteristics of the image of God they bear, there is pain, brokenness... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=4338220 Wed, 12 Jan 2011 06:01:00 +0100 4338220 http://www.medworm.com/index.php?rid=4331265&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F11%2Fbrain-training-it-happens-all-the-time%2F At the risk of seeming untrendy, the trend to rave on about neuroplasticity can be a bit overdone.  Not, I add quickly, because it doesn’t happen, or it’s not important – in fact, quite the opposite – but because it happens all the time.  And at the back of our minds, I think we’ve known this for quite a while.  How else do you think we manage to learn new things even in our elder years? The reason I’m raising this today is, after yesterday’s post on phantom limb pain and the parts of the brain that are active when we have pain and when hypnosis is used for pain relief, I started to mull over the range of treatments that are used in managing chronic pain.  Now, we don’t have fMRI studies for all the treatments available.  I don’t t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4331265 Mon, 10 Jan 2011 21:40:09 +0100 4331265 http://www.medworm.com/index.php?rid=4314171&cid=t_105204_133_f&fid=35098&url=http%3A%2F%2Fclub166.blogspot.com%2F2011%2F01%2Fyour-guest-speaker-has-arrived.html photo credit-SeaDaveCreative Commons licenseLiz related that these were the words that Buddy Boy said when he entered the meeting at the school this afternoon. Was this a disciplinary meeting, an IEP meeting, something worse? No. Buddy Boy's principal (who has a special education background) asked Buddy Boy if he would mind talking to a group of teachers and staff about autism. Dr. D. is a fair person who has high expectations from all of her students, and has also gone out of her way to give Buddy Boy the benefit of the doubt in multiple instances when he has gotten into "situations" at school. We will miss her next year when he goes to middle school (for those that are not regular followers of this blog, Buddy Boy is currently mainstreamed in a regular 5th grade class).Dr. D. had a few l... Club 166 blogs http://www.medworm.com/rss/comments.php?id=4314171 Thu, 06 Jan 2011 03:46:00 +0100 4314171 http://www.medworm.com/index.php?rid=4295018&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F12%2F27%2Ftopic-index%2F After writing for three years, and starting with very limited knowledge of how things like categories and tags worked, there are a lot of posts hidden in my backfiles that might be just what you’re looking for.  So my project is to organise my posts into a topic index!  Here are the first two. ACT – posts about Acceptance and Commitment Therapy, and mindfulness, acceptance and committed action This section is about aspects of acceptance, mindfulness, values, committed action, and ACT, the therapy.  I am no expert in ACT, although I am slowly learning more about the approach.  Several aspects of this therapy appeal to me – firstly the adherence to a research base for it’s effectiveness; the way in which personal values are honoured; the recognition that to achiev... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4295018 Sun, 26 Dec 2010 21:35:55 +0100 4295018 http://www.medworm.com/index.php?rid=4259238&cid=t_105204_180_f&fid=38612&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fpickthebrain%2FLYVv%2F%7E3%2FxNNeH_kqs_Y%2F I read a lot of personal development material, online and offline – and there are two clear competing trends. One school of thought says keep striving for improvement. Keep doing more. Lose weight. Get fit. Make more money. The other says accept yourself just as you are. Love your body. Exercise if you like. Don’t look to money for happiness. Who’s right? Well, both approaches have advantages – and disadvantages: The Self-Improvement Junkies At its extreme, the self-improvement movement preaches the importance of constantly getting better. That has some obvious advantages: You’ll improve your weaknesses – areas which may be holding you back You may well improve your material conditions (your house, car, bank balance, etc) You can achieve great things, accomplishin... PickTheBrain | Motivation and Self Improvement blogs http://www.medworm.com/rss/comments.php?id=4259238 Wed, 15 Dec 2010 07:18:16 +0100 4259238 http://www.medworm.com/index.php?rid=4258798&cid=t_105204_86_f&fid=34445&url=http%3A%2F%2Fwomenshealthnews.wordpress.com%2F2010%2F12%2F13%2Fsunday-monday-news-round-up-way-overdue-edition%2F Some items that have caught my interest recently – I haven’t done one of these in a long time because of work and life and other ponderings about the best current use of the blog, but here are some news items, issues, and commentary of potential interest to readers, on women’s health, feminism, and miscellaneous topics: The CDC provides Consider Cholera: Information for U.S. Healthcare Professionals for clinicians who are asked to be on the lookout for U.S. cases, with info on diagnosis, treatment, and reporting. Aunt B has an excellent commentary in Self-Avowed Feminist, Gail Kerr, Has some Opinions about Emily Evans on the message sent when one female newspaper columnist attempts to trash a female councilperson using language like “shrill” and “class k... Women's Health News blogs http://www.medworm.com/rss/comments.php?id=4258798 Tue, 14 Dec 2010 01:12:21 +0100 4258798 http://www.medworm.com/index.php?rid=4214425&cid=t_105204_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2010%2F11%2F30%2Flying-in-limbo-sort-of%2F waiting... There are a number of limbos that we cancer survivors endure – waiting for test results especially biopsy results, wondering when remission will end, worrying if the treatment will take hold.  By that measure the limbo I currently find myself in is not so much a big deal.  You can always count on cancer to put things into perspective. Where I am is waiting for Unum, my disability insurance company, to decide on extending or terminating my claim.  They have heard from all the doctors, six in number.  But how the dermatologist or otolaryngologist or urologist can shed light on the state of my disability, I have yet to fathom.  Unum have looked at all my recent $50 – $200 pay stubs and the income tax returns for the past two years.  I am just waiting to hear their... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4214425 Wed, 01 Dec 2010 01:07:45 +0100 4214425 http://www.medworm.com/index.php?rid=4200743&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F25%2Fi-dont-know-three-words-we-might-not-be-saying-enough%2F New Zealanders are reeling today after the deaths of 29 miners trapped in a coal mine on the rugged West Coast of New Zealand.  We have watched this drama unfold over the past five days.  We have seen media conferences and we have watched TV footage.  And one of the more frustrating aspects for families has been the refrain “It’s too dangerous to enter the mine.”  The key player in the public face of this disaster has been Peter Whittall, CEO of Pike River Coal Mine.  His ability to answer questions honestly, calmly and with dignity has been a constant source of wonder.  What he must be feeling now can’t be put into words. Throughout this tragedy, the words ‘I don’t know’ have been spoken often.  I think these are some of the bravest words a... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4200743 Wed, 24 Nov 2010 19:58:26 +0100 4200743 http://www.medworm.com/index.php?rid=4183477&cid=t_105204_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2010%2F11%2F19%2Fcancer-lunches-guest-author%2F Cancer Essays by Dorothy Sauber is an interesting website I discovered two nights ago.  The header of the site describes her as a “writer – artist – teacher – mother – citizen”.  Her bio explains that  “She was a voracious reader and disciplined writer. When diagnosed with stage IV non-small cell lung cancer, Dorothy responded by creating a series of 16 essays that explored the many facets of living with a terminal disease. Within these writings one can find the essence of Dorothy’s rich life including her humor, family, philosophy, friends, and her endless generosity. After her death her sons and several friends organized, edited, designed and published Cancer Essays: Not the Book I Was Planning to Write.” The reader has several options... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4183477 Fri, 19 Nov 2010 05:35:07 +0100 4183477 http://www.medworm.com/index.php?rid=4172341&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F17%2Fmedication-and-self-managing-chronic-pain-ii%2F If medication is to be part of a toolkit for self managing chronic pain, then it seems to me that it’s important to know as much about the medication and how it should be used as possible.  Once again, today I’m not directly referring to the literature because I haven’t found an awful lot discussing this integration approach, so please bear this in mind when you read what I’ve written.  I’m also not a medical doctor, I don’t prescribe, I don’t want to have prescribing rights, and I must advise any reader NOT to change, reduce or increase medications without having a good discussion with your own medical practitioner first. There are two main paths in pain management – one focuses on pain reduction, and this is where I think medication (and surgery and... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4172341 Tue, 16 Nov 2010 18:37:08 +0100 4172341 http://www.medworm.com/index.php?rid=4152302&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F11%2Fchronic-pain-in-the-interweb%2F It’s not very often that I’m moved to respond to other blogposts about chronic pain.  When I go onto Google and search for chronic pain SO many awful, quacky, misleading sites come up, promising this and that with so little evidence to support their claims, I’ve tended to avoid looking.  Today, however, thanks to the Neuroscience and Pain Science for Manual Physical Therapists group on Facebook (go Diane!) I was lead to the ever-challenging Science-Based Medicine blog in which a review of the book The Pain Chronicles by Melanie Thernstrom is posted. Now I have not read The Pain Chronicles (by all accounts it looks like a fascinating read), but one of the statements cited in SBM’s review is one of the more profound comments about the management of chronic pain that... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4152302 Wed, 10 Nov 2010 18:43:40 +0100 4152302 http://www.medworm.com/index.php?rid=4152304&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F09%2Fbroaden-and-build%2F Readers may be wondering why I’ve come over all happy clappy and jolly joy germ – well, I realised I’d been writing a lot about experimental and theoretical factors found to influence vulnerability to chronic pain, but I had been writing less about ways to help people cope more effectively with chronic pain. I do have a soft spot for positive psychology because, as we can see in most of the major journals, psychological studies have primarily been interested in what goes wrong, why people may struggle to cope with their pain, and other aspects of vulnerability. Yet more people than not live well with their chronic pain, and rarely seek help for their pain – maybe we can learn something from how these people cope, and in doing so, help people who do need treatment de... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4152304 Mon, 08 Nov 2010 18:40:11 +0100 4152304 http://www.medworm.com/index.php?rid=4122012&cid=t_105204_133_f&fid=35098&url=http%3A%2F%2Fclub166.blogspot.com%2F2010%2F10%2Fif-that.html Good News! Buddy Boy has decided that he likes the clarinet, and wants to play in the school band. For 5th grade music, students have a choice of either taking a "normal" music class, or participating in the band. Buddy Boy chose the band. He wanted to do this when school started, and he wants to do this now.Bad News! We came home to find this letter:"Buddy Boy" is not finding much success in band. He is able to play alone when we do solos, but when the whole group plays, he is not able to focus on what we are doing and participate. He is often taking apart and putting together his clarinet. When he does play with the group, he is overblowing and squeaking quite often. He is probably trying to play louder so he can hear himself, but this causes him to have a poor tone and squeak. "Buddy Bo... Club 166 blogs http://www.medworm.com/rss/comments.php?id=4122012 Sun, 31 Oct 2010 06:28:00 +0100 4122012 http://www.medworm.com/index.php?rid=4119585&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2010%2F10%2Fhearing-wild-heartbeat-in-storm.html I didn't have enough handsto hold the pieces of my brokennessDidn't have enough tearsto dry out my heartBut on the other side of the stormwhere the sunshine is wonderful warmthI've much to liveand more to giveand laughter comes so easy~Other Side of the Cloud, Sarabeth Geoghegan~A half hour east of Chicago, my eyes were a sand-filled abyss of fatigue and my knuckles ached from clutching the steering wheel, as if I could haul myself out of the drag of slumber if only I pulled hard enough on the faux leather grain of the wheel.The clouds stacked up for miles, tens of thousands of feet of mist piled in mounding thunderheads all around the city.  At 4 p.m., the last straggling suburbanites filed out of downtown with lights glowing in the gloom of the gathering storm.  A few fingers o... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=4119585 Tue, 26 Oct 2010 21:51:00 +0100 4119585 http://www.medworm.com/index.php?rid=4061090&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F13%2Fflexibility-of-the-psychological-kind%2F More holiday reading to ponder… One of the fascinating developments in psychology over the past 50 years is the ongoing study into what constitutes psychological health. It’s been known by many names – ego-resilience, executive control and self-regulation – but the work on these areas hasn’t been pulled together into a coherent whole until recently. The authors of this paper suggest that this is partly because of the nature of defining this particular beast – what is health after all? Their argument, and one that I find rather appealing, is that a main feature of health is to be able to apply the right kind of response to the many different situations in which we find ourselves. In other words, flexibility. Occupational therapists in particular will rejo... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4061090 Tue, 12 Oct 2010 18:38:39 +0100 4061090 http://www.medworm.com/index.php?rid=4055968&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F12%2Fcounting-your-blessings-or-looking-on-the-bright-side-of-life-whistles%2F My family were big on the Andrews Sisters. One of my strong memories as a child is listening to the song ‘count your blessings, name them one by one…’ [no, I will not sing it ok?!]. And I remember the book Pollyanna (you can read it for free here!) and the ‘Glad game’ where she looked for the positive in her rather dire situation when she went to live with her strict Aunt Polly. And guess what?  There is something in this approach to coping that makes a difference! While on holiday, sad person that I am, I did spend one or two days reading journal articles.  Several of them were related to the theme of positive psychology in a special issue of Clinical Psychology Review. While research into optimism, positive affect and even psychological flexibility has bee... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4055968 Mon, 11 Oct 2010 18:36:40 +0100 4055968 http://www.medworm.com/index.php?rid=4031304&cid=t_105204_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F10%2F05%2Fbest-of-our-blogs-october-5-2010%2F It’s October and Mental Health Awareness Week! How are you celebrating? Yep, there’s no denying it’s fall. I went to the park this weekend and the crispy air and falling leaves were signs that this is indeed the end of the ease of summer and the beginning of a new season. Every ending has a new beginning and like New Year’s it is another opportunity for self-growth and change. It beckons us to ask the question, “Will I embrace the coming season or mourn the lost of the one before?” If you are courageous, brave and on a mission for change, then you’ll be tickled with this week’s top posts. Why? Do you remember the scene in Bridget Jones’s Diary where Bridget’s enemy Mark Darcy suddenly turns into the love of her life over night wi... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4031304 Tue, 05 Oct 2010 12:32:22 +0100 4031304 http://www.medworm.com/index.php?rid=4018454&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F30%2Fclinicians-and-graded-exposure%2F Some people do, and some people don’t, some of us will, and some of us won’t! Graded exposure can be an uncomfortable experience for both the person who is learning to approach activities that don’t feel very good – and for the clinician! It goes against the grain for some of us to elicit anxiety and see distress as we work with people, after all, our job is to help people feel better isn’t it? There are some consistent findings about clinician anxiety vs patient anxiety when it comes to pain. It seems that clinicians can often be more conservative with regard to what is OK for a person to do than the person can be. This conservatism can be related to clinician’s beliefs about hurt vs harm, clinician’s orientation to a biopsychosocial model –... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4018454 Wed, 29 Sep 2010 17:35:42 +0100 4018454 http://www.medworm.com/index.php?rid=4003454&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F28%2Ffearanxietyavoidance-%25e2%2580%2593-treatments-review%2F For years, clinicians working in pain management have mixed together a rich assortment of strategies to help people function better.  But to identify the ‘active ingredients’ of multidisciplinary pain management using a cognitive behavioural approach, it’s been important to tease each element apart.  One size does not fit all – and just as a physician chooses the most effective medication for a disorder, in time I hope we will be able to choose the most effective strategy for the problems each individual experiences rather than applying our current ‘scatter-gun’ approach. Yesterday I gave a brief overview of the three main treatments to helping people who are fearful/anxious of their pain (or harm) and avoid activities as a result. They are: Graded ex... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4003454 Mon, 27 Sep 2010 18:25:26 +0100 4003454 http://www.medworm.com/index.php?rid=4003101&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F27%2Ffearanxietyavoidance-and-some-treatments%2F I’ve been pondering the post by Neil O’Connell on Body in Mind in which he comments on a paper by Foster, Thomas, Bishop, Dunne and Main (2010) in which he makes the point that “There is a huge emphasis on psychological variables in research and current care for low back pain. My experience (the usual biased, unreliable, non-replicable shambles) tells me that this is justifiably so. But in this rigorous study the four psychological variables found to have a unique influence individually explained just 2.5% of the variance or less. The big players were the level of disability when the patient arrived at the GP and demographic factors which together explained 50%.” Now this flies in the face of the general trend towards emphasising psychosocial variables associated wi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4003101 Mon, 27 Sep 2010 05:35:16 +0100 4003101 http://www.medworm.com/index.php?rid=3969196&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F15%2Fthe-tigger-effect-resilience-emotion-regulation%2F Tigger. That orange-furred, black-striped, tiger character originally introduced in A. A. Milne’s book The House at Pooh Corner. Tigger is a very bouncy fella. Tigger is amongst the most exuberant creatures in the 100 Acre Wood, and his most stand out and well-known feature is his very springy tail. Tigger has resilience. The wonderful thing about Tiggers…..Is Tiggers are wonderful things…..Their tops are made out of rubber…..The bottoms are made out of springs…..They’re bouncy, trouncy, flouncy, pouncy…..Fun, fun, fun, fun, fun…..But the most wonderful thing about Tiggers is…..I’m the only one…..The wonderful thing about Tiggers…..Is Tiggers are wonderful chaps…..They’re loaded with vim and vigor…..T... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3969196 Wed, 15 Sep 2010 09:22:49 +0100 3969196 http://www.medworm.com/index.php?rid=3969197&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F15%2Fwhat-to-do-when-feeling-low-grumpy-or-fatigued%2F Yesterday I wrote about emotion regulation and how this is seen as an essential part of achieving good mental health.  Emotion regulation is about being able to monitor, judge, and work with emotional responses in order to achieve goals. People with chronic pain often experience a range of negative emotions – pain itself is characterised as being a negative emotional and sensory experience. At the same time we know there is an interaction between feeling low and experiencing pain that makes both experiences feel worse. Three of the more troublesome emotions that people experience when they have chronic pain is low mood (not always depression, often ‘demoralisation’ or simply feeling sad and down); frustration and anger; and fatigue. Fatigue you say? Is that an emotion? W... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3969197 Tue, 14 Sep 2010 19:40:31 +0100 3969197 http://www.medworm.com/index.php?rid=3965719&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F14%2Fessential-skills-for-living-with-pain%2F I could actually head this post with the title ‘Essential Skills for Living’ and leave out the pain part, because as I reflect on the events over the past week, and the aftermath as residents of Christchurch start to demolish then rebuild their homes and businesses, these same skills apply. How do people live well despite adversity? Our lives are not straightforward and both major events and daily hassles are encountered and influence thoughts, emotions and behaviour. It’s normal to have a range of emotions, abnormal to be ‘happy, happy, joy, joy’ all the time (despite the adverts!). It has been postulated that the ability to regulate emotions is a sign of adulthood, and that being unable to regulate emotions is a contributor to much emotional ill-health. Emot... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3965719 Mon, 13 Sep 2010 19:36:20 +0100 3965719 http://www.medworm.com/index.php?rid=3982126&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2FaZwjyCm6dWo%2F The Language of Letting Go Our basic recovery concept in 12 Step Fellowships that never loses its power to work miracles is the concept called acceptance. We do not achieve acceptance in a moment. We often have to work through a mirage of feelings – sometimes anger, outrage, shame, self-pity, or sadness. But if acceptance is our goal, we will achieve it. What is more freeing than to laugh at our weaknesses and to be grateful for our strengths? To know the entire package called “us” – with all our feelings, thoughts, tendencies, and history – is worthy of acceptance and brings healing feelings. To accept our circumstances is another miraculous cure. For anything to change or anyone to change, we must first accept others, the circumstance, and ourselves exactl... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3982126 Mon, 13 Sep 2010 15:12:02 +0100 3982126 http://www.medworm.com/index.php?rid=3946702&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F09%2Fheartjolts-and-gap-toothed-smiles%2F Each time I hear a rumble-rattle-creak my heart jolts.  It might be the middle of the night, middle of the day or middle of my shower – these aftershocks are unpredictable and startling.  Yesterday’s 5.1 aftershock at 7:50 or so was a definite heartjolt – halfway through my shower!  With each one, that ‘living on the edge’ feeling comes back – do I need to drop, grab and hold?  Then ‘relax, breathe, calm’ as it passes. Other heartjolts last longer.  Each time I drive past another building tilting on a crazy angle, with terrible cracks and fallen bricks.  Another red ‘condemned’ sign.  Demolition gangs in high-viz vests tearing away at the remaining skeletons of buildings that were hand-made, in an era when each wall was han... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3946702 Wed, 08 Sep 2010 21:39:49 +0100 3946702 http://www.medworm.com/index.php?rid=3921093&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F01%2Fmeasuring-changes-during-graded-exposure-acceptance-treatment%2F I have been pondering about the best way to monitor ‘Matt’s progress during graded exposure therapy for his avoidance of activities involving back movement. I introduced you to Matt yesterday. He’s a ‘man’s man’, a real bloke who, for the past four years since he had surgery for a prolapsed disc, has avoided things like mowing the lawns, making the bed, fishing and whitebaiting and even golf. Yesterday I described how we went through 100 photographs of activities of daily living, and of these, Matt identified 67 of the photographs as things he wouldn’t do because of his concern about both the impact on his pain and the ‘strain’ on his back. I have used a simple count of the number of photographs a person decides is in the ‘avoided... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3921093 Tue, 31 Aug 2010 19:35:59 +0100 3921093 http://www.medworm.com/index.php?rid=3915308&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F31%2Fgraded-exposure-in-the-real-world%2F Well, not exactly the real world – yet – just the clinic. A man I’m working with is very worried about his back.  Some years ago he had a discectomy and his surgeon told him he needed to be ‘very careful’ with his back – and so he has.  No bending, twisting, lifting for this man!  He’s given up some of his favourite things like fishing and whitebaiting and even golf because of this worry, although when I talk things through with him he’s not exactly sure what might happen if he ‘disobeyed’. Let’s call him Matt for wont of a better name (and yes, as usual, details have been changed to ensure confidentiality), and he’s a fairly ‘blokey’ man who loved his fishing, diving, and taking off for days in his conv... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3915308 Mon, 30 Aug 2010 21:02:47 +0100 3915308 http://www.medworm.com/index.php?rid=3903145&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F26%2Fon-being-both-a-scientist-and-a-human%2F Discussion presented at the Occupational Therapy Association, District Of Columbia, St Elizabeth’s Hospital, 1924. Lane, D., Corrie, S. What does it mean to be a scientist-practitioner? Working towards a new vision. Retrieved from http://www.coachingmentoring.co.nz/resources/articles/204-prof-david-lane-what-does-it-mean-to-be-a-scientist-practitioner-working-towards-a-new-vision Thursday, 26 August, 2010. Filed under: ACT - Acceptance & Commitment Therapy, Chronic pain, Clinical reasoning, health, occupational therapy, psychology, research, therapy Tagged: acceptance, Clinical reasoning, health, mindfulness, occupational therapy, research, science, therapy, values (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3903145 Thu, 26 Aug 2010 06:57:02 +0100 3903145 http://www.medworm.com/index.php?rid=3899446&cid=t_105204_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F08%2F24%2Fresilience-and-mindfulness-thoughts-from-two-masters%2F Two legends in psychology — and popular culture — presented at this year’s American Psychological Association Convention. Synonymous with concepts pervasive within education, psychotherapy, and integrative approaches (combining aspects of yoga, medical research, and psychotherapy) Sir Michael Rutter, MD and Steven Hayes, Ph.D. each gave powerful and illuminating presentations. Sir Michael Rutter was introduced by past-APA President Richard Suinn. Sir Michael (Sir/Dr. Rutter?) not only has a voluminous body of writing about resilience, but is considered “the father of modern child psychiatry”. Sir Rutter described the development of his interest, from his family origins to his work studying genetics and coping mechanisms (e.g., Gamezy & Rutter, 1983) to his interest i... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3899446 Tue, 24 Aug 2010 16:08:00 +0100 3899446 http://www.medworm.com/index.php?rid=3896119&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F24%2Finformation-is-to-behaviour-change-as-spaghetti-is-to-a-brick%2F I’m a great fan of books like ‘Explain Pain’. This delightful publication by David Butler and Lorimer Moseley gives accurate information about pain, particularly chronic pain, in an accessible format for both patients and clinicians, and I’ve used it often with people I’m seeing. I’m also a fan of helping people to understand what we do (and don’t) know about pain to give them more awareness of their ability to influence their own body. But as anyone who has worked in chronic pain management knows, telling someone something doesn’t always make an enormous difference – and here’s a case in point.  Before I go on, any cases I refer to on this blog are a compilation of several people and details are altered to protect confidentiali... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3896119 Mon, 23 Aug 2010 19:35:10 +0100 3896119 http://www.medworm.com/index.php?rid=3872755&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F17%2Fvalues-informing-goals%2F Unusually for me, this post is not associated with a piece of published research.  I have been mulling over ways to help people set goals that are really meaningful to them rather than superficial ones that are all too easily forgotten or avoided, and being informed by ACT (Acceptance and Commitment Therapy) I’ve been looking at values clarification as one way of tapping in to this.  At the same time as doing this I’ve been doing a little reading around the occupational therapy Kawa model which uses the river metaphor to describe ‘life flow’, or words to that effect. I’m not a strong advocate of descriptive models really, because I am more concerned about models that help to explain or predict phenomena in the world, but at the same time I use metaphors a lo... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3872755 Mon, 16 Aug 2010 19:35:54 +0100 3872755 http://www.medworm.com/index.php?rid=3823131&cid=t_105204_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2010%2F08%2F04%2Freturning-to-work%2F Back in March of 2004, I walked out of the cancer center where I worked.  I had just found out a week before that my leukemia had returned.  I did not know that this would be my last day as an ‘employed worker’.  I went on medical leave to endure a second round of treatment.  That treatment was successful but we knew that the disease would return, probably sooner than my first 26 month remission.  Again we faced the decision of a bone marrow transplant.  I was two years older now.  Second remissions are harder to achieve as the leukemia cells that survive and sanctuary in the body are the most resistant ones. I was transplanted in August 2004 with stem cells from my brother, Mark.  The rest is a story of survival from then til now, punctuated by a long series of infecti... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=3823131 Wed, 04 Aug 2010 12:01:08 +0100 3823131 http://www.medworm.com/index.php?rid=3802556&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2010%2F07%2Fheld.html A newborn baby is a good example to me, a struggling adult.  My little nephew Robbie loves to be held.  He sleeps right through the sometimes rather jostling transitions from one set of arms to the next, puts up with the childlike mistakes as his little cousins pinch his cheeks, pull on his arms and legs, and kiss him roughly.He's okay with the fact that he has needs.  He doesn't even think about the possibility that someday he'll move beyond those needs...the needs he has for this family he's been planted in.  He just soaks it up.Maybe it's a little easier for him than me.  After all, he probably lacks any vision of independence, and certainly he doesn't have to wonder whether or not he should ask for help.  The cries come, instinctively, when he is hungry, c... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=3802556 Thu, 29 Jul 2010 11:50:00 +0100 3802556 http://www.medworm.com/index.php?rid=3795074&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F28%2Fa-shout-out-to-the-how-to-cope-with-pain-blog%2F One of the most useful, patient-friendly blogs around, How to Cope with Pain Blog has a monthly blog round-up that is always worth reading.  Head to here for this months’ carnival, and while you’re there take some time to read some of the excellent material that has been posted there.  Some of it is written by readers submitting to a recent competition, some of it is written by the author – all of it is worth reading and reflecting on. Filed under: Coping Skills, Education/CME, health, pain Tagged: acceptance, blog carnival, Chronic pain, coping, coping strategies, health, pain management, Resources, self management (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3795074 Wed, 28 Jul 2010 04:23:06 +0100 3795074 http://www.medworm.com/index.php?rid=3795075&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F28%2Fgoals-outcomes-direction-values%2F Someone asked recently, how do you decide the difficulty level of a goal?  Or words to that effect.  It’s a good question – and like most good questions, there doesn’t seem to be a nice clear-cut answer.  So here’s a ramble on where I’ve got to with goals. The first thing I remember about goals is that there is a big difference between a goal that I am aiming for and the actions that I can do to achieve the goal.  What I mean by this is it’s pretty easy to set a goal like ‘I want to get a job by March 2011′ – but this goal could well be setting you up for failure. Why? Not because it’s about working, no, but because it doesn’t depend entirely on your actions – in fact, it depends on an employer deciding that you ar... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3795075 Tue, 27 Jul 2010 19:28:37 +0100 3795075 http://www.medworm.com/index.php?rid=3790764&cid=t_105204_109_f&fid=35451&url=http%3A%2F%2Fwww.jung-at-heart.com%2Fjung_at_heart%2Fthe-quest-for-bothand.html I asked in my last post what obesity is a symptom of, because frankly it is not as clear as might be thought. The desire to pinpoint the cause is all but irresistible. As I have struggled with my weight in my adult life, I wanted desperately to find a reason for it, some explanation that I could rest on. At times I told myself it is all about biology and genetics, an inevitable outcome of being my father’s daughter, as the Fullers are a family replete with fat women who lived long lives. And there is comfort in that explanation because if the reason for my fat is biological, then it is not my fault anymore than my eye color or height is my fault; it is just the way I was made. Other times I would fall to the other side of the coin and believe the cause lay in my psyche. I read Hilda Bruc... Jung At Heart blogs http://www.medworm.com/rss/comments.php?id=3790764 Mon, 26 Jul 2010 14:39:44 +0100 3790764 http://www.medworm.com/index.php?rid=3787135&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F26%2Fmindfulness-and-exercise%2F Now I know this might seem a strange heading when we think of mindfulness practice normally, but this isn’t ‘treatment as usual’. The definition of mindfulness in this study is ‘The body scan practice involves systematically moving awareness through each part of the body and noticing the presence of sensation in a detailed and precise way. This enables contact with the actual sensations of the body (as opposed to thoughts, ideas or fears about these sensations). Mindful movement involves bringing awareness to physical activity, thus allowing movement of the body within the limits of its physical capability. This is taught by means of a comprehensive sequence of movements based on yoga and Pilates.’ I’n not sure I could find a better description of how I ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3787135 Sun, 25 Jul 2010 19:32:20 +0100 3787135 http://www.medworm.com/index.php?rid=3780582&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F23%2Fa-quick-observation-on-using-act%2F The last few weeks and months I’ve been starting to work with people using some of the ACT approach.  For those of you who are unfamiliar with ACT, it involves developing an awareness that what we think and feel is not who we are, that if we are open to experiences (even negative ones) they seem to be less distressing, that being present in the ‘here and now’ helps us to live fully, and by being committed to doing what it takes to live out our values in the real world we will be more able to have the life we really want. This site gives you some great information on ACT (Thanks to Russ Harris, who wrote one of the books on ACT that I’ve found exceptionally helpful ‘Act Made Simple’ published by Harbinger Press) Anyway, back to what I’ve been lea... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3780582 Thu, 22 Jul 2010 19:57:42 +0100 3780582 http://www.medworm.com/index.php?rid=3776629&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F21%2Faccepting-what-life-throws-at-ya%2F This study sought to look at whether the people who are more prepared to accept and be willing to ‘have undesirable psychological experiences without attempting to control them’, might be functioning better and suffer less. The study involved a group of 144 people referred to an interdisciplinary tertiary pain management centre in the UK.  Before treatment, they completed a set of questionnaires including several about acceptance.  And as usual, a whole bunch of statistical things were carried out on the results.  I won’t be too descriptive about these stats, but basically, multiple regression analyses were carried out to ‘establish the contribution of general psychological acceptance to patient functioning, after the variance contributed by patient background ch... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3776629 Wed, 21 Jul 2010 11:17:07 +0100 3776629 http://www.medworm.com/index.php?rid=3772425&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2010%2F07%2Flife-on-beach.html It seems like such an odd place to make a home, yet there they are... thousands of blow holes in the rutted sand where the crabs make their homes deep.  The tides come in and go out, and leave patterns on the sand, yet the crabs hold on tight in the hole they've dug, eat what comes to them, and are perfectly suited to an environment of muck that would detest your average world citizen.We walked a mile or so of the beach without the children one afternoon, hand in hand.  The difficulties of the week and the friction from separation washed away slowly as the waves lapped at our feet and we padded along on the granite-hard sand, packed by wave after wave.  Kind of like trials.  Those waves reduce the sand to it's minimum volume.  Wash away the dross of whatever sand r... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=3772425 Tue, 20 Jul 2010 23:03:00 +0100 3772425 http://www.medworm.com/index.php?rid=3662960&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Falcoholics-anonymous-is-a-haven-of-hope-and-peace-2%2F Twice-Gifted My physical being has certainly undergone a transformation, but the major transformation has been spiritual. The hopelessness has been replaced by abundant hope and sincere faith. The people of Alcoholics Anonymous have provided a haven where, if I remain aware and keep my mind quiet long enough, my Higher Power leads me to amazing realizations. I find joy in my daily life, in being of service, in simply being. I have found rooms full of wonderful people, and for me each and every one of the Big Book’s promises have come true. The things that I have learned from my own experience, from the Big Book, and from my friends in AA – patience, acceptance, honesty, humility, and true faith in a Power greater than myself – are the tools I use today to live my life, th... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3662960 Tue, 15 Jun 2010 04:24:27 +0100 3662960 http://www.medworm.com/index.php?rid=3659161&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Ffocus-onacceptance%2F In 12 Step Fellowships recovery from alcoholism, addiction or co-dependency needs many new concepts to be absorbed and acted upon. One of the most important seems to be Acceptance. “When I focus on what’s good today, I have a good day, and when I focus on what’s bad, I have a bad day. If I focus on a problem, the problem increases; if I focus on the answer, the answer increases.” c. 2001, Alcoholics Anonymous, page 419 See also; The Dry Drunk 12 Rewards of Recovery Touchstones, Daily meditations Sobriety Without End Recovery Promises to … Does AA Work? The Alcoholics Anonymous Big Book Unplugged Hazelden and HCIBooks Online Spirituality Books Inspirational Books Love & Relationships Books Addiction & Recovery Books (Source: Recovery Is Sexy.c... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3659161 Sun, 13 Jun 2010 15:06:01 +0100 3659161 http://www.medworm.com/index.php?rid=3641150&cid=t_105204_125_f&fid=34820&url=http%3A%2F%2Fwww.dentalblogs.com%2Farchives%2Fadministrator%2Fthe-frank-sinatra-principle%2F What does Frank Sinatra have to do with your practice? Follow his lead and you may see your case acceptance numbers rise dramatically. Using the Sinatra Principle, Ken Runkle presents 4 Proven Steps to increasing case acceptance that will have more patients saying “Yes!” right away. Read the entire article. Listen to the companion audio portion at The Paragon Podcast. (Source: dental blog for dentists about dentistry) dental blog for dentists about dentistry blogs http://www.medworm.com/rss/comments.php?id=3641150 Mon, 07 Jun 2010 18:40:06 +0100 3641150 http://www.medworm.com/index.php?rid=3633636&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F06%2Fonline-calm-resources-for-calming-the-mind-and-increasing-emotional-resilience%2F I found this website today CALM – it’s put together by three lecturers at the University of Auckland, and has a whole series of downloadable MP3′s on methods that will help develop resilience and positivity for dealing with life’s ups and downs. Actually, the whole website can be downloaded and played from a computer off-line, which is great if you’re wanting to access this for your personal use. The areas covered are Mental Resilience; Managing Stress, Anxiety and Depression; Healthy Relationships; and Finding Meaning in Life. While each area is dealt with quite briefly, there are loads of worksheets and MP3′s in each area. It’s that part that excites me! The MP3′s cover topics like ‘self hypnosis’ (by Dr Bob Large, Psychiatrist ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3633636 Sun, 06 Jun 2010 01:02:26 +0100 3633636 http://www.medworm.com/index.php?rid=3629896&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F04%2Fdivergent-pathways-in-pain-management%2F I’ve been watching and listening to discussions about what is important in pain management over many years – the debate between reducing pain or improving function as the priority continues.  Often it’s a divergence of opinion between the ‘interventionist’ medical team and the ‘self management’ therapy team – and it can lead to some mighty divisions that don’t seem to resolve.  Of course, it’s not a simple one or the other… but over time the focus can and should change – when the emphasis should shift away from pain reduction is the multi-million-dollar question! In this particular debate, the waters are very murky indeed because, as most of us know, given the possibility of removing or eliminating pain, patients (an... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3629896 Thu, 03 Jun 2010 21:14:55 +0100 3629896 http://www.medworm.com/index.php?rid=3585869&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F21%2Fvalues-and-outcomes-in-pain-management-occupational-therapists-only%2F This post is password protected. To view it please enter your password below: Password: Filed under: ACT - Acceptance & Commitment Therapy, Chronic pain, Clinical reasoning, Coping Skills, occupational therapy, psychology, therapy Tagged: occupational therapy (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3585869 Thu, 20 May 2010 20:27:12 +0100 3585869 http://www.medworm.com/index.php?rid=3577663&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F19%2Fan-accidental-form-of-control-when-mindfulness-produces-happiness-acting-well-living-well-iv%2F I’ve had some success while working with a man I’ll call Peter.  He’s got chronic pain, and has been incredibly fearful of what it might mean – in fact, you’d probably call him a classic catastrophiser because each time his pain flared up he immediately thought it was something like cancer and he would rush off to his GP or the Emergency Department to have it checked out.  Luckily any scans he’s had haven’t shown anything operable because I’m sure with the amount of distress he was been experiencing, he would have been able to persuade a surgeon to operate had there been anything odd-but-common found. We’ve been using mindful breathing as a way to get in touch with the sensations, emotions and thoughts that occur to him, and especiall... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3577663 Tue, 18 May 2010 19:58:08 +0100 3577663 http://www.medworm.com/index.php?rid=3577512&cid=t_105204_125_f&fid=34820&url=http%3A%2F%2Fwww.dentalblogs.com%2Farchives%2Fadministrator%2F5-tips-to-remember-when-creating-digital-case-presentations%2F Here are a few tips to help you stay on the right path when it comes to creating powerful and effective digital case presentations. Less is more.  Too much animation, sound effects, objects, text, etc., can overwhelm your patient, diluting your overall message. The total amount of time you or a team member should invest into one digital case presentation is approximately 35 minutes. Use PowerPoint templates to minimize the time you put into creating the presentation.  Why reinvent the wheel? When altering an image to show potential cosmetic results, remember the purpose is to give the patient an idea of what he or she would look like with cosmetic dentistry.  It is not a diagnostic tool. The patient photos need to show his or her teeth.  Sounds simple and like common sense.  However,... dental blog for dentists about dentistry blogs http://www.medworm.com/rss/comments.php?id=3577512 Tue, 18 May 2010 17:53:04 +0100 3577512 http://www.medworm.com/index.php?rid=3573912&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2010%2F05%2Ftwo-calebs-same-jesus.html It tells of One whose loving heartCan feel my deepest woe;Who in each sorrow bearsA part that none can bear below.Oh, how I love Jesus!Oh, how I love Jesus!Oh, how I love Jesus!Because He first loved me.~ O, How I Love Jesus, by Frederick Whitfield, 1855 ~Sometimes there is something awesome and even frightening about how swiftly, powerfully inexorable the march of time is. Occasionally, I would swear that I can feel the wind as the world turns, and day turns to night and back again. That constant marching of time carries us further away from things we've lost - health and loved ones, yet closer to them with each passing moment as we dance toward death and reunion in heaven. As I sang my children to sleep for their naps today, a haunting memory flooded over me. Another little Caleb...a dif... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=3573912 Mon, 17 May 2010 20:26:00 +0100 3573912 http://www.medworm.com/index.php?rid=3573967&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F18%2Fact-ing-well-living-well-iii-acceptance-willingness%2F One thing that strikes me as very different about the ACT approach is the very different way therapists are encouraged to respond to difficult emotions.  Part of ACT is to encourage acceptance of, and ‘sitting with’ negative thoughts or emotions or sensations rather than attempting to change them or ignore them – and in my learning about ACT and trying to model ACT consistent behaviour in therapy, I find I need to become more mindful of my own responses to other people’s thoughts and emotions. What I mean by this is that I initially have a response to avoid experiencing another person’s distress – so if the person I’m working with is tearful or angry or afraid, I have often tried to mop up the tears or calm the person down or reassure them.  What... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3573967 Mon, 17 May 2010 19:43:46 +0100 3573967 http://www.medworm.com/index.php?rid=3570085&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F17%2Fa-dilemma-act-ing-well-living-well%2F In this study, an intervention in which individuals considered their personal values (in other words, what is important to them, what influences the direction in which they take actions) was carried out, and its influence on tolerance to a cold pressor test was evaluated. Two previous studies have shown that low levels of experiential avoidance and high acceptance are reportedly related to higher pain tolerance, conversely one would expect that high levels of experiential avoidance and low levels of acceptance would be related to lower tolerance to pain.  A couple of definitions here: pain tolerance is about how long a person is prepared to ‘put up with’ pain before attempting to move away from it, as opposed to pain threshold which is the point at which the person identifies ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3570085 Sun, 16 May 2010 19:21:00 +0100 3570085 http://www.medworm.com/index.php?rid=3549591&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F10%2Fact-ing-well-living-well-ii%2F The second in a series about ACT and its use in pain management from an occupational therapy point of view. My last post (here) talked about ACT and ‘doing what matters’, or ‘valued action’ – this involves identifying what is important to a person, then helping them do it, while being careful not to encourage ‘experiential avoidance’, or avoiding coming into contact with experiences we’d rather not. Here’s the ‘hexaflex’ or diagram that provides an overview of ACT.  What ACT tries to develop in people is ‘psychological flexibility’, or the ability to be in the here and now, open to experiences (even negative ones) and do what matters to live a life in alignment with what is important.  In people who lac... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3549591 Mon, 10 May 2010 06:23:26 +0100 3549591 http://www.medworm.com/index.php?rid=3549592&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F10%2Fact-ing-well-living-well%2F For some time I’ve been learning more about ACT – Acceptance and Commitment Therapy (normally pronounced ‘act’, not A – C – T).  While I have to admit that I have been flummoxed by relational frame theory, a behavioural theory of human language and cognitionthat underpins ACT (go here for a tutorial that may enlighten somewhat), there are some very simple principles that ACT employs that I’ve found useful in my own life – and in the lives of people I work with. Over the next few days I want to outline a bit more about ACT and how I use it within pain management – I’ll be referring to journal papers that explore the use of ACT in pain management, but a lot of what I’ll cover comes more from my own experiences with moving fro... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3549592 Sun, 09 May 2010 23:33:21 +0100 3549592 http://www.medworm.com/index.php?rid=3556380&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2FdP0Rr9rrjwY%2F Self-forgiving is: Accepting yourself as a human who has faults and makes mistakes. Letting go of self anger for your past failures, errors, and mistakes. No longer needing penance, sorrow, and regret over a grievous, self-inflicted, personal offense. The act of self love after you have admitted your failure, mistake, or misdeed. The spiritual self healing of your heart by calming self rejection, quieting the sense of failure, and lightening the burden of guilt. The act of letting go of the need to work so hard to make up for your past offenses. Lack of self forgiveness can result in: A loss of love for yourself. Indifference toward yourself and your needs. An emotional vacuum in which little or no emotions are shown or shared. Chronic attacks or angry outbursts against self. Disrespe... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3556380 Sun, 09 May 2010 17:57:24 +0100 3556380 http://www.medworm.com/index.php?rid=3530051&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F04%2Frelaxation-how-why-the-evidence%2F Over the weekend a discussion about relaxation and the how’s and why’s came up in a discussion group I belong to. Several members of the group, including me, contributed our ‘list of do’s and don’ts’, much of it based on years of clinical experience – until I thought (as I do!) what about the literature? What does research tell us about precautions and effectiveness of relaxation? I have to say that my searches in the literature so far have failed to consider many of the practical tips that the group came up with, but I have found some really helpful reviews of relaxation that support its use in pain management.  One of those more recent references is the one I’m focusing on today. At the same time as wanting to briefly look at the evidence ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3530051 Mon, 03 May 2010 19:28:35 +0100 3530051 http://www.medworm.com/index.php?rid=3526921&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2010%2F05%2Fmid-night-journal.html Be careful for nothing; but in every thing by prayer and supplication with thanksgiving let your requests be made known unto God. ~ Philippians 4:6This verse is an oldie, but goody (my brother Daniel used to say that as a small boy, and it still tickles me deep within to say it). Tonight I am up as the first pink glaze of sun appears in the pines out my bedroom window, heralding the end of night and beginning of another morn...up all night trying hard to put actions to this verse. It has been a night of prayer, a night of reading, a night of closing my eyes in near delirium and still the prayers flow and the sleep does not come.How many times had patients sat there waiting for her to announce her decision after a similar moment of respite? Invariably the decision was based on science and s... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=3526921 Mon, 03 May 2010 08:58:00 +0100 3526921 http://www.medworm.com/index.php?rid=3467955&cid=t_105204_133_f&fid=35082&url=http%3A%2F%2Fblog.gbrettmiller.com%2Fhis-decision-not-mine%2F A few years ago, a friend asked me the question: “If someone told you there was a pill you could give your son that would cure his autism overnight, would you give it to him?” Sounds like an easy question, right? I hadn’t really thought much about it for some time, as it had been nearly ten years since his autism diagnosis, so I answered with a very non-committal, “I don’t know, I guess so.” That evening I gave the question some more serious thought, and was surprised by I learned. If the child study team that gave us the diagnosis had asked that question right after giving us the diagnosis, when our son was just barely three years old, I would not have hesitated. I would have given him the pill right then and there, no questions asked. (Well, maybe “do you take credit cards?... 29 Marbles blogs http://www.medworm.com/rss/comments.php?id=3467955 Tue, 13 Apr 2010 22:00:49 +0100 3467955 http://www.medworm.com/index.php?rid=3463767&cid=t_105204_133_f&fid=35082&url=http%3A%2F%2Fblog.gbrettmiller.com%2Fneglect-or-good-parenting%2F The following ties in well with my recent post Parents should be leaders (not managers) and my overall theme for Autism Awareness Month, so I’m reposting it in its entirety.  I first posted this in April of 2008. - – — — —– What would you think if your friend/neighbor/sibling told you that they had left their 9 year old son at a department store in mid-town Manhattan, by himself, because “he had been begging for me to please leave him somewhere, anywhere, and let him try to figure out how to get home on his own”? Would you call Child Protective Services, or would you say “good for you”? Would you ever do something like that? After you’ve had a chance to think about it for a second, check out the essay Why I Let My 9-Year-Old Ride the Subway ... 29 Marbles blogs http://www.medworm.com/rss/comments.php?id=3463767 Mon, 12 Apr 2010 23:00:55 +0100 3463767 http://www.medworm.com/index.php?rid=3460369&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2010%2F04%2Fwhen-life-takes-you-by-surprise.html Art is the stored honey of the human soul,gathered on wings of misery and travail. ~ Theodore Dreiser ~ I spent a day that might have been spent at the research conference traipsing through art museums with the girls instead. Life is what happens when your plans tank and you find yourself without even a plan B. Life is what gathers you up in a bear hug when you scramble to survive. Small heads tilted to see big art. Minds free from adult constraints find new meaning in old pieces and old meaning in new ones. I am reminded of a hundred museum trips of my youth, and marvel at how I am mirroring my own childhood now as I shape that of my own children.I know only one true North: Christ. I see it in the false compass of an artist, in the childish splatter of a museum's modern art collection. Am... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=3460369 Mon, 12 Apr 2010 10:00:00 +0100 3460369 http://www.medworm.com/index.php?rid=3453956&cid=t_105204_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F04%2F09%2Fbest-of-our-blogs-april-9-2010%2F Happy Friday! Hope everyone has an exciting weekend planned, even if “exciting” means sleeping in and vegging out in front of the TV. I don’t know about you, but I love this early spring weather, when the sun’s out, large clunky sweaters get stored away and tank tops and flip flops finally show their face. However, for some the warm weather brings up other things like spring cleaning, getting organized, taxes (ack!), a reminder of what we haven’t accomplished from our 2009 New Year’s Resolution, or our body image issues. In regards to the latter, ever notice that the two most busiest times at the gym are after New Year’s and spring? What’s great is that I’m noticing a new trend, one that has to do with self-acceptance regardless of size... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3453956 Fri, 09 Apr 2010 12:51:17 +0100 3453956 http://www.medworm.com/index.php?rid=3449067&cid=t_105204_133_f&fid=35082&url=http%3A%2F%2Fblog.gbrettmiller.com%2Fdysfunction-as-high-function%2F During his New Year’s Day seminar, author Dan Pink shared five trends that he is following in 2010. In the science category, the trend he is keeping an eye on is dysfunction is high function. During the discussion he referenced the Atlantic Monthly article The Science of Success, which considers the possible “up-side” of genetic dysfunction: Yes, this new thinking goes, these bad genes can create dysfunction in unfavorable contexts—but they can also enhance function in favorable contexts. Re-reading the article last night reminded me of a story I heard, and wrote about, several years ago. Here is a slightly edited version of what I wrote back then. - – — — —– From McGee’s Musings is this personal story of someone else who, on learning m... 29 Marbles blogs http://www.medworm.com/rss/comments.php?id=3449067 Thu, 08 Apr 2010 11:52:34 +0100 3449067 http://www.medworm.com/index.php?rid=3449198&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F04%2F08%2Fgoals-how-relevant-are-they%2F A few posts ago I discussed a motivational strategy that had been shown to help people be specific about the benefits of exercise and plan to overcome obstacles that may prevent them from engaging in it (Christiansen, Oettingen, Dahme and Klinger,2010). Today’s post relates to this as I read an editorial written by Schrooten & Vlaeyen about that same study in which it is pointed out that goals are a very complex concept, and that to simply identify the pro’s and con’s of a single activity that has been ‘imposed’ on the person might fail to address one of the most important aspects of goal setting – the relevance or context of the goal itself. I’ve written quite often about goals and goal-setting, mainly reflecting that setting goals is a pretty... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3449198 Wed, 07 Apr 2010 19:38:26 +0100 3449198 http://www.medworm.com/index.php?rid=3443852&cid=t_105204_125_f&fid=34820&url=http%3A%2F%2Fwww.dentalblogs.com%2Farchives%2Fadministrator%2Fthree-small-steps-for-big-results-starting-points-to-increasing-case-acceptance%2F With so much happening in the economy and in healthcare today, you may find yourself running into more and more obstacles with your patients when it comes to case presentation and case acceptance. Have you started hearing new objections?  Are you hearing more objections about money?  Are more concerns circling around fear for the future when it comes to healthcare coverage?  These are not times to sidestep and avoid the unavoidable.  These are also not times to back away from presenting the best possible care to your patients because you are afraid to hear no – again.  What it is time for is a Back to Basics approach on patient care and case presentation.  Here is where you can start. In a recent report by the ADA, it was stated that 51.6% of adults stated they would be more likely... dental blog for dentists about dentistry blogs http://www.medworm.com/rss/comments.php?id=3443852 Wed, 07 Apr 2010 13:42:56 +0100 3443852 http://www.medworm.com/index.php?rid=3440983&cid=t_105204_133_f&fid=35082&url=http%3A%2F%2Fblog.gbrettmiller.com%2Fcultivate-your-kids-strengths%2F I found this bit of wisdom in the book Never Eat Alone by Keith Ferrazzi. Though geared at self improvement, this quote struck a chord with me as a parent: The trick is not to work obsessively on the skills and talents you lack, but to focus and cultivate your strengths so that your weaknesses matter less. The story of Tony DeBlois is an example of this in action. His mother recognized that Tony had serious weaknesses/disabilities to overcome, but also realized that his strength in music could make much of that weakness irrelevant. All of our kids have their own strengths. Much of it may be hidden from us as parents*, or their strength may be something that we don’t quite understand or appreciate as worth cultivating. But it is by cultivating these strengths, in all of our kids (and o... 29 Marbles blogs http://www.medworm.com/rss/comments.php?id=3440983 Tue, 06 Apr 2010 12:20:18 +0100 3440983 http://www.medworm.com/index.php?rid=3437857&cid=t_105204_133_f&fid=35082&url=http%3A%2F%2Fblog.gbrettmiller.com%2Fdont-write-them-off%2F Seth Godin doesn’t write about autism, and yet much of what he writes and says comes across as if it were written just for the parents of an autistic child. Today’s article – Accepting limits – from his blog is a perfect example (emphasis is mine): Isn’t it absurd to focus so much energy on ‘practical’ skills that prep someone for a life of following instructions but relentlessly avoid the difficult work necessary to push someone to reinvent themselves into becoming someone who makes a difference? And isn’t it even worse to write off a person or an organization merely because of what they are instead of what they might become? Much of what counts as autism intervention these days focuses on making the child – or the adult - “more ... 29 Marbles blogs http://www.medworm.com/rss/comments.php?id=3437857 Mon, 05 Apr 2010 12:45:27 +0100 3437857 http://www.medworm.com/index.php?rid=3435028&cid=t_105204_87_f&fid=34872&url=http%3A%2F%2Fblisstree.com%2Ffeel%2Ffalling-in-love-with-help-from-divorce%2F Over the last week I’ve learned that four of my women friends are in various stages of divorce. Four – that’s about a third of my yogini friends, all in their 30s. One was horribly betrayed; another is trying to keep her two young kids psychologically intact even though she’s feeling liberated; a third is in the throes of triage-level couples’ therapy; and a fourth is spent from years of “eating glass” to make someone else happy. Yikes. As the irony gods would have it, in the midst of these conversations – listening, nodding, feeling their pain, wondering why anyone would be insane enough to link their happiness to another human being – I’m falling deeply in love for the first time in a zillion years. It’s like cruising by four fatal car crashes during your driver... Healthbolt blogs http://www.medworm.com/rss/comments.php?id=3435028 Fri, 02 Apr 2010 17:58:53 +0100 3435028 http://www.medworm.com/index.php?rid=3429368&cid=t_105204_133_f&fid=35082&url=http%3A%2F%2Fblog.gbrettmiller.com%2Fa-theme-for-autism-awareness-month%2F Every year when April – otherwise known as Autism Awareness Month – rolls around, I ask myself, “Awareness? Awareness of what exactly?” Most times I forget my own advice and try to find a “one-size-fits-all” answer to the question. (My advice: there is no such thing as one-size-fits-all for anything.) Some times I just bail on the question altogether. This year I decided to try something different. Instead of trying to go “big picture” awareness, I’m going to focus on one aspect – a theme, if you will – of autism awareness. A consistent theme throughout all the various incarnations of this blog, not to mention my life as the parent of an autistic son, has always been that autistic people are just people like everyone else, w... 29 Marbles blogs http://www.medworm.com/rss/comments.php?id=3429368 Wed, 31 Mar 2010 22:47:03 +0100 3429368 http://www.medworm.com/index.php?rid=3411295&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2F2osR98ZZUnQ%2F Awareness, Acceptance and Action “The Three A’s” can be an extremely powerful tool in coming to terms with our alcoholism/ addiction or codependency. The first part of this tool is Awareness. We shatter our denial by becoming aware of our feelings and the nature of our disease. We do this by listening at meetings and identifying with other members’ feelings and experiences. As our contact with others who have similar issues increases and our willingness to participate in our recovery increases, we find that our awareness also increases. The temptation to take action at this point is strong. Yet, it is wise for us to wait until we truly know what it is we are trying to change! Acceptance comes when we are willing to admit our feelings and experiences to ourselves and... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3411295 Thu, 25 Mar 2010 10:37:10 +0100 3411295 http://www.medworm.com/index.php?rid=3404168&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F03%2F25%2Fwondering-does-targeting-specific-outcomes-have-an-effect%2F I’ve recently read a couple of studies of group-based CBT for chronic pain showing that outcomes are both durable and cost effective – and I started to ponder a little, as I do. So far, it seems that no-one can identify the vital ingredients in a CBT approach that ‘do the work’ or create the greatest change.  Despite the various studies that have been done, most of them treat the contents of a programme as some sort of ‘black box’ into which people are  taken, emerging some weeks later having made changes that then last.  But some studies have found that 12 months later the specific ’skills’ that individuals were shown during a programme (and carried on using 1 – 6 months later) have been dropped, but the positive changes in terms of... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3404168 Wed, 24 Mar 2010 18:30:49 +0100 3404168 http://www.medworm.com/index.php?rid=3391016&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F03%2F22%2Faccepting-chronic-pain%2F How willing are you to have persistent pain? Can you accept pain without fighting against it? If you were told your pain was going to be there forever, would you avoid important activities or would you start to get back into life again? Recently I reviewed about 200 questionnaires completed by people attending the Pain Management Centre where I work. I was looking especially at what they’d written down as goals for coming to the Centre, and unsurprisingly, most of them were to ‘reduce my pain’ – to tolerable levels, to manageable levels, or so the person could begin ‘living a normal life’. I hate to break it to you – even the most effective medication seems to only reduce pain by about 30%, and most people wanting pain reduction are after at least ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3391016 Sun, 21 Mar 2010 18:21:45 +0100 3391016 http://www.medworm.com/index.php?rid=3370706&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F03%2F17%2Fsetbacks%2F A couple of days ago I mentioned the satisfaction I feel when a person I’ve been working with faces a setback and manages it successfully on their own for the first time.   Someone replied saying that we all face pain setbacks alone, so what did I mean really – and I thought today I’d quickly expand on what I did mean! Chronic pain persists (goes without saying) but its pattern is to fluctuate from time to time and often without clear provocation – so it’s not very helpful to try and look at what ’caused’ the pain to change.  Yet this is so often what we as clinicians ask about, and more often what the person experiencing the pain tries to do.  Flare-ups happen irrespective of how hard we try to avoid them, so it’s useful IMHO to group fla... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3370706 Tue, 16 Mar 2010 18:23:08 +0100 3370706 http://www.medworm.com/index.php?rid=3374387&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Facceptance-is-the-answer-3%2F The Language of Letting Go Our basic recovery concept in 12 Step Fellowships that never loses its power to work miracles is the concept called acceptance. We do not achieve acceptance in a moment. We often have to work through a mirage of feelings – sometimes anger, outrage, shame, self-pity, or sadness. But if acceptance is our goal, we will achieve it. What is more freeing than to laugh at our weaknesses and to be grateful for our strengths? To know the entire package called “us” – with all our feelings, thoughts, tendencies, and history – is worthy of acceptance and brings healing feelings. To accept our circumstances is another miraculous cure. For anything to change or anyone to change, we must first accept others, the circumstance, and ourselves exactl... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3374387 Tue, 16 Mar 2010 17:52:44 +0100 3374387 http://www.medworm.com/index.php?rid=3366274&cid=t_105204_109_f&fid=35451&url=http%3A%2F%2Fwww.jung-at-heart.com%2Fjung_at_heart%2Fchecking-bias.html Around a year ago, I wrote about my reaction to Irvin Yalom's essay, "Fat Lady".  At that time, I wrote: How is a fat person, who, no matter the reasons for being fat, certainly has a whole host of emotional issues about her size and her body -- how is such a person to find the courage to talk about those feelings in the presence of someone who finds her as disgusting as she herself often does? How can she roar her anger at the prejudice she encounters? How is she to arrive at being able to care about her body and for herself lovingly rather than with contempt and hatred? And supposing she doesn't want to devote herself to losing all that weight? Supposing she wants to get off the diet merry-go-round and concentrate on being healthy and fat (and yes, that is possible)?   The op... Jung At Heart blogs http://www.medworm.com/rss/comments.php?id=3366274 Sat, 13 Mar 2010 17:56:20 +0100 3366274 http://www.medworm.com/index.php?rid=3346733&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2FFQaSVgL25e8%2F This article will give many people in recovery food for thought. What is a healthy relationship and how does sex fit in? In the simplest terms, a healthy relationship is one that makes you feel good about yourself and your partner. Not only do you enjoy being together, but you can express your true self, and allow your partner to do the same. All relationships are different, of course, but healthy ones have at least five important qualities in common. The acronym S.H.A.R.E. can help you remember these qualities. Safety: In a healthy relationship you feel safe. You don’t worry that your partner will harm you physically or emotionally, and you don’t feel inclined to use physical or emotional violence against your partner. You can try new things (such as taking a night class) or c... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3346733 Mon, 08 Mar 2010 06:56:44 +0100 3346733 http://www.medworm.com/index.php?rid=3292035&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F21%2Fwhy-do-i-spend-so-much-energy-time-on-chronic-pain%2F Someone said recently that they’d like a job where they come in, do the job, then go home and have a life.  Later that day I spent an hour or so after work talking to another clinician who, like me, has occasionally been accused of ‘not having a life’ – oh and breaking a few rules to get a good outcome for someone.  We both thought that in health care, at least in New Zealand, there are more people who live and breathe their passion for their work than those who don’t, and that our work is more enjoyable and more exciting than when we’ve ever been working in a job that needs less energy.  I can also say that I’d rather be seen by someone who loves their job than someone who is simply waiting to go home… There’s a saying I put on the ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3292035 Sat, 20 Feb 2010 23:01:34 +0100 3292035 http://www.medworm.com/index.php?rid=3290951&cid=t_105204_133_f&fid=35082&url=http%3A%2F%2Fblog.gbrettmiller.com%2Fwhats-in-a-label-autism-aspergers-and-the-dsm-v%2F Several years ago, I wrote a two part article on my thoughts about whether autism should remain in the DSM. Here’s what I came up with: For now, we need to keep autism in the DSM, because it serves as the way for autism parents to help their children get the services they need to succeed in the world. The current draft of the DSM V, available for review and comment, still includes autism – now referred to as Autism Spectrum Disorder (instead of  Autistic Disorder). However, the DSM V proposal recommends that Asperger’s Disorder and Pervasive Development Disorder Not Otherwise Specified (PDD-NOS) “be subsumed into an existing disorder: Autistic Disorder (Autism Spectrum Disorder)“. As you might imagine, there has been a lot of discussion about this. I’m ... 29 Marbles blogs http://www.medworm.com/rss/comments.php?id=3290951 Fri, 19 Feb 2010 23:25:37 +0100 3290951 http://www.medworm.com/index.php?rid=3280210&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F17%2Fgoals-and-satisfaction-with-pain-management%2F This study does all of this, and the language used and methods described mean it’s easy to see how they arrived at their conclusions. The findings from this study of 86 people who completed all measures showed that goal attainment scaling was a more sensitive measure of satisfaction than outcomes from any other questionnaires (using multiple regression analysis).   Satisfaction with progress was more stronly related to personal functional goal achievement than to more traditional outcome measures including pain, disability, fear-avoidance, lifting, trunk flexibility and treadmill endurance. Why would we worry about patient satisfaction? Good question if you are only worried about getting someone to go through a process and not as interested in what matters to the person you’r... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3280210 Tue, 16 Feb 2010 18:34:18 +0100 3280210 http://www.medworm.com/index.php?rid=3259299&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F10%2Fan-interview-with-f-sommer-anderson-central-sensitisation-syndromes%2F How many of you have headed off to ‘Therapy Worksheets’ blog? Yes, that’s the one I’ve linked to in my roundup of the best CBT resources on the internet.  Will Baum, the editor of that blog is also the author of where the client is, a blog about professional private practice in mental health care.  Will contacted me the other day and sent me a link to a really interesting interview with Frances Sommer Anderson, a clinical psychologist who works with people experiencing chronic pain.  Her take on chronic pain management is influenced by John Sarno, who has a hypothesis that much chronic pain is influenced by psychological factors (often emotional issues) from childhood.  One of the premises of his approach is that people need to heal their ‘repressed’... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3259299 Wed, 10 Feb 2010 07:45:32 +0100 3259299 http://www.medworm.com/index.php?rid=3254753&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F09%2Fhow-do-you-establish-who-will-do-well-with-pain-management%2F Some people just won’t do well with pain management.  In just the same way as a surgeon selects good candidates for surgery, so people need to be selected for self management.  Although there is some truth that getting even a little pain management is good for everyone, the cost of doing so in staff energy and the effect on other participants can make it a very unrewarding task. How do you work out who is in and who is out? I’ve used a ‘readiness for change’ model, following Prochaska and diClemente’s ’stages of change’ approach for some time now.  This uses the idea that if we work with people at their level of readiness, we’ll reduce resistance to our efforts, and we can target our approach to suit. The problem with this lies in trying t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3254753 Mon, 08 Feb 2010 18:32:11 +0100 3254753 http://www.medworm.com/index.php?rid=3251401&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Facceptance-and-surrender%2F Compliance and Acceptance; Submission and Surrender By Dr Harry Tiebout, an early friend of AA who wrote extensively about alcoholism and AA. This edited article illustrates an often subtle but devastating state of mind in recovering alcoholics. Dr Harry Tiebout In alcohol treatment and recovery one fact must be kept in mind, namely the need to distinguish between submission and surrender. In submission, an individual accepts reality consciously but not unconsciously. He accepts as a practical fact that he cannot at that moment conquer reality, but lurking in his unconscious is the feeling, “There’ll come a day” — which implies no real acceptance and demonstrates conclusively that the struggle is still going on. With submission, which at best is a superficial yieldi... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3251401 Mon, 08 Feb 2010 13:08:41 +0100 3251401 http://www.medworm.com/index.php?rid=3247081&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2Fl9KjCMfnmxk%2F Accept “When I focus on what’s good today, I have a good day, and when I focus on what’s bad, I have a bad day. If I focus on a problem, the problem increases; if I focus on the answer, the answer increases.” c. 2001, Alcoholics Anonymous, page 419 See also; Abstinence-based Recovery Related Reading: (Source: Recovery Is Sexy.com) Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3247081 Sat, 06 Feb 2010 02:24:19 +0100 3247081 http://www.medworm.com/index.php?rid=3236104&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2FFQgee-9Gc10%2F Alcoholics Anonymous members have made the Serenity prayer part of recovery. It asserts five basic elements of the recovery program. A belief in something other than ego-self Serenity – one of the goals of recovery Acceptance of …, e.g., loss of control Courage to make changes Wisdom of recovery that is gained from other members, Spirituality, meditation and literature God grant me the Serenity to Accept the things I cannot change, Courage to change the things I can, and Wisdom to know the difference. Whether we belong to this church or that, whether we are humanists, agnostics, or atheists, most of us have found these words a wonderful guide in getting sober, staying sober, and enjoying our sobriety. Whether we see the Serenity Prayer as an actual prayer or just as a ferven... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3236104 Mon, 01 Feb 2010 11:53:01 +0100 3236104 http://www.medworm.com/index.php?rid=3216847&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2FXYU94D3INWo%2F Focus on Acceptance In 12 Step Fellowships recovery from alcoholism, addiction or co-dependency needs many new concepts to be absorbed and acted upon. One of the most important seems to be Acceptance. “When I focus on what’s good today, I have a good day, and when I focus on what’s bad, I have a bad day. If I focus on a problem, the problem increases; if I focus on the answer, the answer increases.” c. 2001, Alcoholics Anonymous, page 419 See also; What is AA? The Dry Drunk 12 Rewards of Recovery Touchstones, Daily meditations Related Reading: (Source: Recovery Is Sexy.com) Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3216847 Thu, 28 Jan 2010 12:45:12 +0100 3216847 http://www.medworm.com/index.php?rid=3200667&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FRecoveryIsSexycom%2F%7E3%2FPreUvLXkWn0%2F Acceptance People in 12 Step Fellowships often struggle with acceptance. Not just acceptance of powerlessness over their disease but many other things as well. God grant me the serenity To accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference. –Reinhold Niebuhr Some things I cannot change I need to accept as is: my age, who my relatives are, my eye color, my height, my childhood experiences, my inborn talents, my nature, someone else’s abuse of alcohol or other drugs, whether the sun will shine, my job history, what I will inherit, how my parents feel, yesterday’s lost opportunities, how long I will live, who forgives me, how my parents treated me, how much I am loved, the past. Some things I can change: the ... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3200667 Fri, 22 Jan 2010 11:54:41 +0100 3200667 http://www.medworm.com/index.php?rid=3185659&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F01%2F19%2Fwhen-in-danger-when-in-doubt-just-remember-deep-breath-in-deep-breath-out%2F It was a physio who first chanted that wee slogan at me some ten years ago… for a physio, he wasn’t bad at all! Come to think of it, I have worked with some great physiotherapists (please don’t let them know!).  Anyway, it’s been one of those sayings that I’ve carried with me ever since he taught me, and it actually works. One of the simplest, easiest and least intrusive coping strategies for pain has to be diaphragmatic breathing. I’ve always thought it work partially because it buys a little time – a bit like ‘counting to ten’ to stop you losing your temper! And I’ve often used breathing techniques because it works so quickly on physiological arousal…it’s one of the few aspects of arousal level that we can conscious... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3185659 Mon, 18 Jan 2010 19:41:37 +0100 3185659 http://www.medworm.com/index.php?rid=3182401&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F01%2F18%2Fdepression-demoralisation-and-cbt-for-everyone%2F I was roving through my Twitter feed this morning,when I got word (via Gail Eva) of a paper debating the introduction of an enormous amount of money to provide CBT to people in England with anxiety and depression. The paper is in the British Journal of Psychiatry here and it’s available in its entirety. While there is no doubt that in New Zealand there are plenty of people with mental health problems who simply do not get seen within the mental health system, it’s difficult to know whether an initiative like this one in the UK will ‘fix’ the problem. We’ve seen similar increases in the number of especially men start to openly acknowledge depression which has made the job of getting help to them much easier (especially in the chronic pain population), but I do ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3182401 Sun, 17 Jan 2010 21:34:14 +0100 3182401 http://www.medworm.com/index.php?rid=3172224&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F01%2F14%2Fdo-people-use-the-same-ways-of-coping-over-the-lifetime-of-their-pain%2F This is a bit of an unanswered question – do people use the same coping strategies at the beginning of their experience with chronic pain, or are there shifts in coping as time goes on? I’ve been pondering, as I do when writing my PhD, about the ways we have studied ‘coping’ in chronic pain.  It’s like researchers have conceptualised coping as a static trait rather than a developmental journey, and this is something I’m struggling to accept. Definitions of coping have emphasised that coping consists of ‘purposeful efforts to manage the negative impacts of stress’ (Lazarus & Folkman), and my guess is that many factors influence the choice of specific strategy.  Some that spring to mind are: how the event is construed – is it &#821... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3172224 Wed, 13 Jan 2010 19:36:26 +0100 3172224 http://www.medworm.com/index.php?rid=3167479&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F01%2F13%2Fattention-please-attention-management-for-chronic-pain%2F A debate that’s been going on for some time is the role of ‘distraction’ in pain management. So many of the people I see have told me they ‘just ignore’ the pain, or ‘I try to distract myself’, or similar, that there isn’t much doubt to me that people habitually use attention management as a coping strategy – yet the research findings have been quite mixed, especially with respect to ‘distraction’ and ‘ignoring’ pain. Pain is naturally an attention-grabber. That’s one of the main purposes of acute pain, IMHO, to attract attention and direct the person to DO something in response. Of course in chronic pain, there is little to DO, so the person needs to redirect attention away from pain and back into the task... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3167479 Tue, 12 Jan 2010 19:51:04 +0100 3167479 http://www.medworm.com/index.php?rid=3139257&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Falcoholic-recovery-narcissism%2F Narcissism A Barrier to Personal Acceptance of the Spiritual Aspect of Alcoholics Anonymous Twenty-nine newly recovering alcoholic outpatients drawn from a Minnesota-Model type treatment program in the United Kingdom completed the NPI narcissism scale and the “Steps Questionnaire.” Results showed the narcissistic “authority” subscale showed a very strong inverse relationship to level of personal acceptance of [...] (Source: Recovery Is Sexy.com) Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3139257 Sun, 03 Jan 2010 15:59:44 +0100 3139257 http://www.medworm.com/index.php?rid=3089600&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F12%2F15%2Fbut-im-not-ready-to-stop-looking-for-a-cure%2F People come to pain management with a wide range of attitudes and expectations.  Over the past few months I’ve been reviewing the ‘goals’ that people write in their pre-appointment psychometric questionnaires, and almost without exception people write ‘Reduce my pain’ or ‘Fix my pain’.  While they’ll also write down ‘do more’, ‘return to work’, ‘get a life back’ – these things are all ‘provided that…my pain is gone’. I spent a half hour talking to a man yesterday who has spent seven years searching for firstly ‘the reason’ for his pain, and now ‘the cure’ for his pain.  He told me he’s not yet ready to accept that his pain might be permanent.  His li... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3089600 Mon, 14 Dec 2009 18:33:10 +0100 3089600 http://www.medworm.com/index.php?rid=3071493&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F12%2F09%2Fnorways-national-guidelines-for-evaluating-pain%2F I don’t envy the job of health economists – nor policy-makers or politicians who need to make the difficult decisions about who should receive allocation within the restricted health funding that is available.  At the same time, I’m often worried when I hear that ‘high-tech’ treatments, and those that are perceived as ‘glamour’ health problems get funding when low-status problems like chronic pain get overlooked.  So it was nice to read that Norway has enshrined the rights of people to receive evaluation and treatment for chronic pain within law. The National Guidelines for chronic pain ’seek to answerthe difficult questions of which patients should be prioritised at pain clinics and what is a medically acceptable waiting time.’ It h... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3071493 Tue, 08 Dec 2009 22:38:38 +0100 3071493 http://www.medworm.com/index.php?rid=3067277&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2009%2F12%2Fin-nutshell.html These words perfectly capture my initial reaction and the prayerful opening of my fists to accept the gifts of labors, pains, sorrows, and all of life's Novembers.http://www.aholyexperience.com/2009/12/its-part-of-receiving-gift.html (Source: Turquoise Gates) Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=3067277 Tue, 08 Dec 2009 14:10:00 +0100 3067277 http://www.medworm.com/index.php?rid=2999879&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F17%2Fgoing-with-the-flow-emotion-regulation-and-coping%2F I’m in two minds about attempting to regulate emotions. From ACT, and in particular, mindfulness, I’m learning that trying to control emotions and thoughts is darned near impossible – and unhelpful. From the research on the effect of pain on emotions and subsequently on self regulation, goals and coping, it seems that pain strongly influences emotion and that negative emotions in particular, influence the range of coping strategies and goals we choose – and success or failure in turn generates further emotion, and so on. As Hamilton, Karoly and Kitzman say ‘the primary function of pain is to disrupt other ongoing activities and to direct attention toward the cause of injury or the extent of tissue damage’ – of course, in chronic pain, there may no ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2999879 Mon, 16 Nov 2009 18:29:34 +0100 2999879 http://www.medworm.com/index.php?rid=2996047&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F16%2Ftheories-of-emotion-self-regulation-and-pain%2F Can chronic pain be a force that shapes how we go about responding to challenges within our environments? Does chronic pain influence how we feel emotionally about daily activities that contribute to overall goals, and perhaps negatively bias the way we think about the process of setting and achieving goals? I’ve already concluded that having pain doesn’t mean people can’t do what they want to do, but it certainly makes it harder and less enjoyable.  Today’s post will briefly look at two theories that link emotion, cognition and pain.  Once again, I’m drawing from a paper written by Hamilton, Karoly & Kitzman (2004). These authors refer to two theories – the first being a two-factor model developed by Carver and colleagues in which it is proposed... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2996047 Mon, 16 Nov 2009 07:35:42 +0100 2996047 http://www.medworm.com/index.php?rid=2981393&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F11%2Fwhat-do-i-do-when-ive-had-enough-the-effect-of-emotions-on-self-regulation-chronic-pain%2F As soon as read the first paragraph of the paper I’ve used as the basis for this post, I knew I was onto something that resonated with my original occupational therapy values. It says this: ‘Living with chronic pain is a balancing act. People with chronic pain are required to make daily decisions about how best to cope with illness-related demands while managing other role-related obligations. Although some people become overwhelmed by the demands of illness and daily life, many, if not most, remain focused and well-adjusted, and do not require the services of a mental health professional. … Why do some redouble their coping efforts following a health set back, whereas others become demoralised?’ I concur with the idea that ‘most remain focused and well-adjust... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2981393 Wed, 11 Nov 2009 06:15:44 +0100 2981393 http://www.medworm.com/index.php?rid=2977601&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F11%2F10%2Fself-regulation-what-it-is-and-what-to-do%2F So, if self regulation is about exerting control over thoughts, feelings, actions and physiology, how does it work? When I skipped through some Google references last night (o font of all knowledge!) I found a good number of sites referring to self regulation and children – but not nearly as many relating to adults, or the long-term results of limited self regulation. Curious in our world where kids get to ‘express themselves’ and are protected from disappointment, have few challenges set (especially those where they have to persist with difficult tasks), and don’t need to think about consequences for themselves because parents and teachers do it for them… Hmmmm When I got to reading though, self regulation really is what much of pain management is all about. ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2977601 Mon, 09 Nov 2009 18:34:33 +0100 2977601 http://www.medworm.com/index.php?rid=2970349&cid=t_105204_129_f&fid=39065&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fgluten-freesimplicity%2FGNKb%2F%7E3%2FA2UnRdEpngM%2F All I am suggesting is that people who have been diagnosed with Gluten-Related health problems can possibly help themselves (and those around them) if they grieve their losses in a healthy way. (Source: Gluten-Free Simplicity) Gluten-Free Simplicity blogs http://www.medworm.com/rss/comments.php?id=2970349 Sat, 07 Nov 2009 12:35:25 +0100 2970349 http://www.medworm.com/index.php?rid=2947104&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2009%2F10%2Fstill-frame-in-rushing-water.html I shall know why, when time is over,And I have ceased to wonder why;Christ will explain each separate anguishAnd I, for wonder at his woe,I shall forget the drop of anguish,That scalds me now, that scalds me now.~ from Emily Dickinson's Time & Eternity, 1926 ~It was a golden, crisp autumn afternoon: October 8th, the last day I remember Amelia healthy in the recent past. We went to the park to play Pooh sticks off the bridge I used to walk as a child. Today has been a tough day. I think the stress is starting to hit home a bit. I feel like I am spinning wheels when I am doing anything other than tending to, absorbing, or cuddling my children - any of the four of them. And unfortunately, I can't have all four together in one room due to the unknown origin of Amelia's infection (she is in... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=2947104 Sat, 31 Oct 2009 04:22:00 +0100 2947104 http://www.medworm.com/index.php?rid=2934953&cid=t_105204_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fwhat-is-codependence-%25e2%2580%2593-a-room-of-mama%25e2%2580%2599s-own%2F The Isolation of Codependency What Is Codependence? – From A Room of Mama’s Own. ….. But codependence (or codependency) is harder to define and to recognize. After all,   codependents can seem, to themselves and others, like hapless victims, in the wrong place at the wrong time. Or they can be perceived (especially by the codependent) as doing good work rather than harm, because the harm they are doing is largely to themselves. But if addiction is an unhealthy attempt to escape trauma, codependence is an unhealthy attempt at damage control. More at; A Room of Mama’s Own. Related Reading: Share/Save (Source: Recovery Is Sexy.com) Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=2934953 Wed, 28 Oct 2009 03:25:39 +0100 2934953 http://www.medworm.com/index.php?rid=2931310&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F27%2Fit-was-a-piece-of-cake-hypnosis-for-sleep-and-tummy-pain%2F After briefly looking at hypnosis yesterday, I found this lovely case study written by Leora Kuttner of an 11 year old girl with problems going off to sleep, including tummy pain and anxiety. The girl had been through CBT, and introduced to the idea that she had a ‘worry bug’, and that the way to rid herself of the ‘worry bug’ was to ‘climb the fear ladder’. The ‘fear ladder’ being a graded hierarchy where her mother would gradually ease away from her side when going off to sleep. The problem being that this little girl kept waking as her mother left the room – and would start to panic. At 11 years old, this wasn’t exactly the best thing for her, given that girls like to go to sleep-overs! Apparently this young girl had always bee... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2931310 Mon, 26 Oct 2009 18:33:51 +0100 2931310 http://www.medworm.com/index.php?rid=2905140&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F19%2Ffeeling-the-pain-distractionrelaxation-or-exposure%2F It’s not the pain, it’s the judgement of the pain that makes it so distressing – or at least, that’s how the cognitive behavioural model of pain views our experience of pain. As a result, most pain management therapies working to help people manage when their pain can’t be removed involves reviewing how people judge their pain. Of course, we’ve all had experience of pain since we were babies (at least, those of us with normal nervous systems), so we’ve all learned that pain is not something to enjoy and that it’s really something we should avoid. This works well when it’s short-term or acute pain, we learn not to do whatever caused the pain, and we carry on in life a little wiser. When pain persists, we usually bring this same judgement... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2905140 Sun, 18 Oct 2009 18:36:29 +0100 2905140 http://www.medworm.com/index.php?rid=2894786&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F15%2Faccepting-low-back-pain-is-it-related-to-a-good-quality-of-life-2%2F This study is another from the Bath University stable, this time from a PhD study carried out by Dr Victoria Mason and supported by Beth Mathias and Dr Suzanne Skevington. Mason’s PhD was around developing a chronic pain component/module to the World Health Organisation’s Quality of Life measure, the WHOQOL, and this study was a part of the larger programme. Quality of life is one of those terms that I’ve never really taken to – it’s always felt quite nebulous. The WHO definition of quality of life is ‘‘‘an individual’s perception of their position in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.’’ Hmmm, suitably broad, so reasonably difficult to me... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2894786 Wed, 14 Oct 2009 18:34:35 +0100 2894786 http://www.medworm.com/index.php?rid=2891024&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F14%2Fact-some-evidence-for-acceptance-commitment-therapy-in-chronic-pain%2F This study was carried out with a group of over 100 participants attending a pain management programme.  Two measurement times were used – at the time of screening for acceptance onto the programme and at the time participants started treatment, with a period of 18 weeks or so between them.  None of the participants in the study had active treatment, so this is simply a study of the relationship between one variable at one point in time, and another variable at another point in time without intervention.  Although you could argue that assessment is an interventions, and it’s certainly something we’ve observed at Pain Management Centre. While its a correlational analysis (remember, no conclusions about causation!), it’s notable that ‘acceptance of pain and v... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2891024 Wed, 14 Oct 2009 06:01:02 +0100 2891024 http://www.medworm.com/index.php?rid=2886781&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F13%2Facceptance-worksheets-and-more%2F Trying to help someone begin the process of accepting chronic pain is no easy task. My observation is that people need time to recognise that their pain problem is not acute pain  (so it won’t ‘heal’), and go through the process of seeking ‘the cause’ (so the ‘cure’ can be found), then begin the long process of adjusting expectations and renegotiating the new ’self’ as the person moves toward a life living with pain rather than fighting it. I also recognise that this path isn’t linear, rather it’s tortuous, winding back and forth from emotion to emotion as treatments are offered, more investigations are available, as anger and resentment and deep sadness emerge when new losses are experienced.  Some people may have their p... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2886781 Mon, 12 Oct 2009 18:24:07 +0100 2886781 http://www.medworm.com/index.php?rid=2883228&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F12%2Facceptance-in-chronic-pain%2F It’s a truism that no-one really wants to have pain (and if they do, we probably need to ‘talk’!).  Accepting pain may be equated with ‘giving up hope’ or ‘giving in’ – perhaps acceptance is thought to be about resignation rather than acknowledgement.  In any event, very few of the people I work with seem to be ready to acknowledge the reality of having pain and at the same time being aware of the ability to also experience joy, peace, fun and all the other good things in life. I’m not entirely surprised by this when I consider the way we’re raised to believe that: (1) pain is bad and must be avoided (2) doctors are all-powerful and can fix anything if only they try hard enough (except the common cold – but we can take ant... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2883228 Sun, 11 Oct 2009 19:26:01 +0100 2883228 http://www.medworm.com/index.php?rid=2881155&cid=t_105204_86_f&fid=34445&url=http%3A%2F%2Fwomenshealthnews.wordpress.com%2F2009%2F10%2F11%2Fweekly-news-round-up-1011%2F The National Advocates for Pregnant Women reports that the United States Court of Appeals for the Eight Circuit issued a decision in a case of an incarcerate woman who was shackled to the bed during labor, finding the practice “cruel and unusual” and thus unconstitutional. “Our Bodies, Ourselves” has been translated and adapted into a number of languages and cultures over the years; Christine writes about progress on Hebrew and Arabic versions. Nikki has H1N1 resources for children. RH Reality Check reports on the Limited-Service Pregnancy Centers Disclaimer Bill proposed in Baltimore to ensure that women visiting a Baltimore “crisis pregnancy center” are informed that they will not receive comprehensive birth control or abortion services or referrals... Women's Health News blogs http://www.medworm.com/rss/comments.php?id=2881155 Sun, 11 Oct 2009 17:08:49 +0100 2881155 http://www.medworm.com/index.php?rid=2865895&cid=t_105204_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2009%2F10%2Fuglybeautiful.html Courgette ratatouille brings a beautiful dash of autumn color to a stained stovetop.Vegetables prepped in the washer =bad idea if you have a high efficiency tumbler!Skins and tomato shreds on clothes for days afterward =ugly.Fascination of children garnered by a novel use of an ordinary appliance =beautiful.An ugly counter strewn with seeds and sticky juice is made beautiful by the glisten of red in a favorite yellow enamel pot."This is why cultivating once again one’s own sense of aesthetics, and raising future generations to appreciate beauty, should be seen as a profound obligation by God’s people. And there is no more appropriate time of the year to remind ourselves of this than when we commemorate the horrific ugliness of Christ’s Passion followed by the splendor of His Resurrec... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=2865895 Tue, 06 Oct 2009 13:16:00 +0100 2865895 http://www.medworm.com/index.php?rid=2862760&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F05%2Fcoping-what-is-it%2F Some of you will know I’ve been striving to write my PhD proposal lately, ending up with loads more words than actually necessary! However, as part of it I’ve been reviewing some of the material I’ve collected over time on coping. Coping is one of those difficult words - one we all know, but don’t always define especially well. One definition of coping is ‘purposeful efforts to manage the negative impact of stress’ – this one’s by Lazarus & Folkman. This definition suggests that coping involves active choices about what to do in the face of stress. Wikipedia (o font of all knowledge) defines coping as ‘managing taxing circumstances, expending effort to solve personal and interpersonal problems, and seeking to master, minimize, reduce o... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2862760 Mon, 05 Oct 2009 07:15:49 +0100 2862760 http://www.medworm.com/index.php?rid=2890838&cid=t_105204_129_f&fid=39065&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fgluten-freesimplicity%2FGNKb%2F%7E3%2F5mLwKQ_ulWY%2F Just because one if Gluten-Free does not mean that Depression will be gone for always. (Source: Gluten-Free Simplicity) Gluten-Free Simplicity blogs http://www.medworm.com/rss/comments.php?id=2890838 Sat, 26 Sep 2009 21:20:54 +0100 2890838 http://www.medworm.com/index.php?rid=2832289&cid=t_105204_125_f&fid=34820&url=http%3A%2F%2Fwww.dentalblogs.com%2Farchives%2Fadministrator%2Fstatistics-on-dental-emergencies-in-the-us%2F In a PR Newswire post regarding a Majestic Drug survey, we learn some interesting statistics that may not shock you, but will inform you. One in six Americans experienced a dental emergency in the past year. Seventy-two percent of Americans have fillings, caps, or crowns, and 23 percent of dental emergencies relate back to these restorations. In these situations, 67 percent of respondents went directly to a dentist, and 14 percent tried to find a temporary solution. Nineteen percent did nothing. The survey revealed that out of a thousand people, respondents with an annual income under $35K had a higher instance of dental emergency than those with an income exceeding $100K. How can you help your patients avoid a dental emergency? Inform them. Education, not fire-and-brimstone, but solid... dental blog for dentists about dentistry blogs http://www.medworm.com/rss/comments.php?id=2832289 Fri, 25 Sep 2009 15:39:59 +0100 2832289 http://www.medworm.com/index.php?rid=2828476&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F24%2Fmeaning-focused-coping-looking-for-the-good-things-in-dark-times%2F I’ve been reading about ways to increase resilience and help people develop strengths to cope with pain, and came across this blog post on Positive Psychology News where Kathryn Britton reviews several papers by Susan Folkman and others who look at ways of coping.  I’ve posted before on the Lazarus and Folkman model of coping here and here. Their original model described a path from Appraisal –> Coping –> Outcome –> Emotion, with two outcomes after a harmful or threatening event. The first outcome was simply to favorable resolution and positive emotion. The second outcome, led to an unfavorable resolution and distress, with a loop back to the appraisal process labeled negative emotion.  This model has been updated by Susan Folkman to include the imp... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2828476 Wed, 23 Sep 2009 19:20:53 +0100 2828476 http://www.medworm.com/index.php?rid=2820279&cid=t_105204_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F09%2F22%2Fuse-caution-with-positive-thinking%2F Back in July, John Cloud wrote a piece for “Time” Magazine called “Yes, I Suck: Self-Help Through Negative Thinking.” In the article, Cloud lays out the research why “cognitive restructuring,” the process of retraining your thoughts–of changing self-defeating attitudes to constructive ones–simply doesn’t work. Actually, it’s worse than that. Sometimes when we tell ourselves statements that we don’t really believe (”I’m good enough, I’m smart enough, and gosh darn it, people like me”), it can decrease the little self-esteem we had to begin with. As I mentioned in my post “Happy Thoughts Can Make You Sad,” this is precisely why Dr. Smith told me to stay away from self-help books when I was s... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2820279 Tue, 22 Sep 2009 15:56:08 +0100 2820279 http://www.medworm.com/index.php?rid=2774933&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F08%2Fpatient-determined-outcomes-if-you-cant-take-my-pain-away-then-at-least-let-me-do-more%2F If I had a dollar for every time that I’ve asked someone what they would like from pain management and they’ve answered ‘take my pain away’ – well I wouldn’t be writing this blog early in the morning before work! The findings from this piece of research by Thorne and Morley (2009) suggests that people think an acceptable reduction of pain should be about 45 – 75% – but most pain treatments achieve about 30 – 50%.  Part of the process of receiving treatment seems to be helping people become more accepting of a higher level of pain but an improved level of function. A couple of points from this paper really interested me – one was the acknowledgement that most outcome measures in research are determined by the researchers themselve... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2774933 Mon, 07 Sep 2009 22:17:56 +0100 2774933 http://www.medworm.com/index.php?rid=2752042&cid=t_105204_125_f&fid=37825&url=http%3A%2F%2Fbibbynews.wordpress.com%2F2009%2F08%2F31%2Fseptember-is-craniofacial-acceptance-month%2F Each September the Children’s Craniofacial Association (CCA) celebrates Craniofacial Acceptance Month. CCA is dedicated to improving the quality of life for people with facial differences and their families. The CCA webiste includes information for patients and families on craniofacial disorders as well as links to programs, services, networking and more. If [...] (Source: Bibby Library News and Tips) Bibby Library News and Tips blogs http://www.medworm.com/rss/comments.php?id=2752042 Mon, 31 Aug 2009 15:08:35 +0100 2752042 http://www.medworm.com/index.php?rid=2747908&cid=t_105204_86_f&fid=34445&url=http%3A%2F%2Fwomenshealthnews.wordpress.com%2F2009%2F08%2F30%2Fweekly-news-round-up-83009%2F Lots of stuff at Our Bodies Our Blog, as usual. Emily Douglas is leaving RH Reality Check for The Nation. If you’ve appreciated her work at RHRC, go wish her a fond farewell. Rachel Maddow interviewed Dr. LeRoy Carhart, an abortion provider in Nebraska whose clinic is being protested by Operation Rescue this weekend. He appeared wearing a large badge that reads, “Trust Women.” frau sally benz is staring up a feminist book club (online), Radical Readers & Feminisms for Dummies – visit jump off the bridge to sign up. Renee at Womanist Musings has a bunch of stuff worth reading in her weekly round-up. I particularly liked Chally at Zero to the Bone’s In Which Homework is Assigned, with commentary on and links to things to read on disability and access. F... Women's Health News blogs http://www.medworm.com/rss/comments.php?id=2747908 Sun, 30 Aug 2009 16:14:10 +0100 2747908 http://www.medworm.com/index.php?rid=2741624&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F28%2Fwhat-is-self-management-in-chronic-pain%2F Self management. It’s term we use very often in pain management, but do we really agree about what we’re talking about? Maybe self management is different things to different people, maybe even different things to different people at different times! But if we don’t talk about what we’re aiming for, especially if we’re in a team that don’t talk – we’re bound to run into trouble. Self management has been defined by academics in several ways, which doesn’t help, but all the definitions seem to include concepts of wellbeing, activities that the person with the health condition does, and encounters with the health system. The Institute for Healthcare Improvement states that self management includes three things: care of the body and manag... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2741624 Thu, 27 Aug 2009 19:44:09 +0100 2741624 http://www.medworm.com/index.php?rid=2727076&cid=t_105204_86_f&fid=34445&url=http%3A%2F%2Fwomenshealthnews.wordpress.com%2F2009%2F08%2F23%2Fweekly-news-round-up-82309%2F Lots of stuff at Our Bodies Our Blog as usual. One I didn’t get around to linking last week is a piece about how Washington State is attempting to reduce c-sections by equalizing Medicaid reimbursements for vaginal birth vs. (non-emergency) c-section. The New York Times Magazine has a special issue this week on women, including an interview with Secretary of State Hillary Clinton on her approach to global women’s issues. The National Sexuality Resource Center has launched the Cool Aunt campaign, centered around the trusted adults in a child’s life when s/he is unwilling or unable to obtain needed information about sex and growing up from her/his own parents. I’m often thought I would give the nieces/nephews a copy of S.E.X when they’re a little older (it&#82... Women's Health News blogs http://www.medworm.com/rss/comments.php?id=2727076 Sun, 23 Aug 2009 16:33:14 +0100 2727076 http://www.medworm.com/index.php?rid=2705112&cid=t_105204_86_f&fid=34445&url=http%3A%2F%2Fwomenshealthnews.wordpress.com%2F2009%2F08%2F16%2Fweekly-news-round-up-16%2F Comments are working again at OBOS – we had some technical difficulties this week, but have new posts up on Wyeth Pharmaceutical’s ghostwriting of papers on hormone replacement therapy (to gloss over the risks), with the Colbert Report’s take and continued featuring of a copy of OBOS as part of the women’s health g graphics. Also, Christine’s critique of a pregnant-looking-women-breakdancing campaign (you really just have to read it). NaCl and hv has a series of how-to posts on bringing babies to conferences. I’m a little bummed that the Childcare entry doesn’t include “encourage conference organizers to provide childcare.” The Allied Media Conference manages to provide childcare and a kids’ track, which I assume increases the abi... Women's Health News blogs http://www.medworm.com/rss/comments.php?id=2705112 Sun, 16 Aug 2009 17:20:05 +0100 2705112 http://www.medworm.com/index.php?rid=2671064&cid=t_105204_137_f&fid=35426&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheAlzheimersReadingRoom%2F%7E3%2FF_GBdUOvW5s%2Fmy-alzheimers-mantra.html Each morning when I wake up, and right after I brush my teeth.I look in the mirror and say,I am not Alone.I am the One.I am an ALZHEIMER'S caregiver.Somehow these words always brings a smile to my face. They send me into my day with a positive attitude.Each night before I get into bed, I brush my teeth.When I finish, I look into the mirror and say,I am not Alone.I am the One.I am an ALZHEIMER'S caregiver.These words empower me. They bring into focus my vision and my mission.I will be writing shortly about two days in my life that changed me. The day when I realized--I was not alone.The day when I realized--I was the One.Along with these realizations, I came to the realization that I had accepted Alzheimer's into my life.I decided that acceptance was a good thing, but it was not enough. I f... Alzheimer's Reading Room, The blogs http://www.medworm.com/rss/comments.php?id=2671064 Tue, 04 Aug 2009 18:43:53 +0100 2671064 http://www.medworm.com/index.php?rid=2657926&cid=t_105204_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F07%2F31%2Fseeing-people-progress%2F A quick post this morning before I search for some Friday funnies! I saw a few patients this week after having had just over a fortnight off work – and you know how sometimes working in pain management can seem unrewarding, progress can be incredibly slow, one step forward, two sideways… Well here are some progress reports from some of the people I’ve been seeing (names and details changed to protect identities). Hypnosis for intermittent phantom pain First up is a man with a 10 year history of below knee amputation. He wears a prosthesis, is fit and active, and until late last year was working full time. Over the latter half of last year he developed intermittent severe stabbing phantom pain (prior to this he had phantom sensation with some stump pain but never phantom p... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2657926 Thu, 30 Jul 2009 19:39:40 +0100 2657926