Charlie Brown:
It seems there are MANY of us who are interested in your notes about health anxiety. (Mine worry is early onset Alzheimer's disease. I am 40). Would it be possible for you to post your notes in this forum (even if it's a long text, that's OK) so people wouldn't worry about giving out personal email addresses?
hypocondria - PLEASE HELP!!!
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Charlie Brown
- Posts: 442
- Joined: Mon Sep 04, 2006 2:56 pm
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Charlie Brown
- Posts: 442
- Joined: Mon Sep 04, 2006 2:56 pm
Managing Medical Symptoms
Session One Summary Patient Handout: Shifting Attitudes
1) Old Attitude: Every symptom has a definitive medical explanation.
New Attitude: Many symptoms have no clear cause, or definitive medical explanation. This does not mean they are grave or life threatening.
2) Old Attitude: Somewhere there is a doctor who can cure my symptoms.
New Attitude: There comes a point where I can choose to stop seeking a medical explanation and cure, accept that my symptoms may not go away, and start to learn to cope with my symptoms.
3) Old Attitude: Unless I get rid of my symptoms completely, I won't feel any better at all.
New Attitude: I can decrease discomfort and improve the quality of my life by changing my beliefs, assumptions, and feelings about my symptoms. I can learn to interpret symptoms in non-frightening and more realistic ways.
4) Old Attitude: Good health means being symptom free. So, if something is wrong, it must be a disease.
New Attitude: Even healthy people experience sensations and symptoms regularly. Many symptoms are caused by normal bodily changes in response to activity, stress, emotions, and other benign causes. I can learn to accurately label these sensations then ignore them.
The way in which I interpret and think about sensations and symptoms greatly influences how intense and disturbing they seem. The more threatening I believe the cause to be, the more I will experience the symptom as painful. Symptoms I believe to have "normal" causes will seem much less intense than symptoms I attribute to disease.
5) Old Attitude: If my doctor has not found a cure for me yet, he/she must not be that concerned about me or my medical problems.
New Attitude: My doctor takes my concerns seriously, and wants me to feel better. However, there are limits to medical knowledge, and not all symptoms have known cures. There are other ways to cope with these symptoms effectively, even if they cannot be cured.
***How to make this information work for you***
Consider how each attitude might apply to your target symptom. Is there an attitude that contributes to your distress and that you now feel ready to challenge? Select one of the new attitudes to start practicing with your symptoms. Be patient as you test it out several times and reinforce the new belief.
Managing Medical Symptoms
DIAPHRAGMATIC BREATHING
Session One Patient Handout
Points of Emphasis
1) You can practice diaphragmatic breathing in a seated or lying position. Eventually you will be able to use relaxed breathing even while standing or moving. Choose a position with your back supported and straight, avoid being bent at the waist. Wear loose clothing so your waist and abdomen can expand freely.
2) Practice diaphragmatic breathing for ten minutes twice a day to start. Practice the diaphragmatic breathing technique for a few minutes, take a break to breath as you normally do, then return to a few minutes of diaphragmatic breathing. You do not need to do the ten minutes continuously in the beginning.
3) If you feel dizzy or lightheaded, or you feel tingling in your lips or fingertips, stop practicing and go back to your regular way of breathing until those sensations pass. Review the instructions before your next practice session, and take care to avoid hyperventilating or overbreathing.
Diaphragmatic Breathing Instructions
1) Choose a comfortable position, and loosen any tight clothing. Relax the muscles of your shoulders, back, and chest. Most important, relax your belly, so it can expand with each breath.
2) Breathe in through your nose to warm and filter the air. Breathe out through your mouth, with lips pursed to hold the air passages open longer. Once you are comfortable with this technique, you can inhale and exhale through your nose.
3) Place your hand lightly on your abdomen, just above the navel.
4) Exhale slowly through pursed lips while gently pressing on your abdomen. This empties the lungs, and makes room to inhale fresh air.
5) Now begin the cycle: inhale slowly and easily through the nose. Pause for a second. Now exhale slowly and completely through the mouth with lips pursed. It may take longer than you expect! It takes about twice as long to exhale as it does to inhale. Pause, then begin the next cycle as your body begins to inhale. Take all the time you need for each breath in, and each breath out.
6) It may take several breaths before you feel your breath flowing easily and deeply. You will begin to feel your hand rise about an inch or so when you inhale, and then fall every time you exhale. Inhale, belly rises and hand rises; exhale, belly falls, hand lowers. Your aim is to settle into a smooth, even rhythm. Don't worry about moving large amounts of air in and out of your lungs. The even, rhythmic flow is more important.
Try A Mental Focus
Once you have the basic movements down, you might like to add a mental focus. Experiment
with a few different types of mental focus techniques to see which one you prefer.
1) Imagine that there is a balloon right behind your navel. As you inhale, the balloon inflates,
your belly expands out. As you exhale, the balloon deflates, your belly flattens as the air flows
out.
2) You might like to imagine your breath flowing like the gentle waves of the ocean, flowing into the shore and then flowing back out again... a smooth, even rhythm, very soothing and relaxing.
3) You can repeat a phrase with each breath. For example, inhale, exhale and say "relax" or "let go."
4) Count from one to four as you inhale, then from one to four as you exhale.
Be patient and keep up your practice! If you have questions, bring them to the next session.
Managing Medical Symptoms
Session Two Summary
Patient Handout
Attention
Attention is one of the main influences on how we feel physically. The amount of attention we pay to symptoms influences how intense the symptoms feel. The more attention we direct to a symptom, the more it hurts or bothers us. For example, banging your shin on a chair while you are home alone will be more painful than banging your shin while skiing with friends. In the latter case, you would be distracted by having fun and being with friends so you would hardly notice the injury. While home alone, you would focus intently on the painful sensation and blossoming bruise.
Attention is also one of the main influences on how we feel emotionally. Focusing on a symptom raises your anxiety level. The more one focuses, the more serious and worrisome the symptom becomes. When intense attention is combined with anxiety, physical changes take place that make it seem that the symptom is getting worse, even though the cause of the symptom remains the same.
Just as increasing the attention you give a symptom increases sensitivity and discomfort,
lessening the attention you pay will lessen discomfort. Distraction is an effective way to shift
your attention away from unpleasant physical sensations and worrisome thoughts.
Many people have developed a fine-tuned sensitivity to what goes on inside their body. This sensitivity contributes to unpleasant sensations and worry. The good news is that the same sensitivity will make it easier for you to learn relaxation. Relaxation training helps reduce stress and anxiety.
***How to make this information work for you***
Select a symptom that has been checked out by your doctor and for which no serious cause has
been found. Rate the symptom on a scale of 1-5, with 5 being most bothersome. For five
minutes, focus intently on the symptom, imagining the cause and what is going on inside. Let
the worried thoughts you often have come in. Then rate the symptom from 1-5 again. Which
direction did your rating go? .
Now select a distraction technique, and practice it for 10 minutes. Rate your symptom one last
time. Did your ratings change?
When you notice yourself focusing attention on a symptom, take a break to practice relaxation or to distract your attention. The goal is to break the cycle of symptom perception by reducing attention, anxiety, and the frightening meaning attached to the symptom. Even if the symptom doesn't go away, you will feel more in control and less bothered.
Managing Medical Symptoms
Session Two
Patient Handout: Distraction Techniques
Distraction can redirect conscious awareness away from bothersome sensations and repeated
worries. A number of techniques are described below, but any constructive, absorbing activity is
a good choice.
1) Go through the alphabet, naming varieties of soup, i.e., A = asparagus, B = bean, C = cream of mushroom. Name all 50 States.
2) Do a simple task such as washing dishes, watering plants, fix something. Give the activity your full attention.
3) Spend time on an enjoyable craft project: knitting, needlepoint, woodworking, stringing beads. Write in a journal, draw, doodle, or paint.
4) Focus on the outside world. Stand by a window and count the cars going by. Describe the changes you notice in your garden or front yard since last week.
5) Replay a happy moment in your memory as if watching a movie. Use all your senses to make the scene come alive, i.e., try to imagine the temperature, the sounds around you, the quality of the light, a breeze, etc.
6) Try rhythm. Sing along with the radio, drum with your fingers, recite poetry, or pet a cat.
7) Concentrate on planning an activity you are looking forward to.
8) Games are a great distraction: computer games, cards, crossword puzzle, word games.
9) Telephone someone who has a good sense of humor. Deliberately avoid talking about
symptoms or health. .
10) Take a warm bath or shower. Focus on the scent of the soap, the comfort of a fluffy towel. Make it a pleasurable experience.
11) Exercise or take a walk.
12) Massage your face/neck/hands/shoulders/feet with fragrant lotion.
Managing Medical Symptoms
Patient Handout: Brief Relaxations
Session Two
Brief relaxations are additional ways to use the diaphragmatic breathing technique to give you the opportunity to reduce bodily hyperarousal, step away from a stresso^ and refocus on a healthier perspective. Brief relaxations work best when scheduled into your day at frequent intervals, every 1-2 hours.
These relaxations are easy to do even if you are new to relaxation:
1) Countdown breathing: Close your eyes or gaze softly at the floor. Take a breath in, and as you exhale, say "Ten." Take another breath in, a little slower and deeper. As you exhale, say "Nine." Continue counting down to zero with each breath. Feel the tension draining out of your body with each exhalation.
2) At work in a busy office, pick up a telephone and put it on hold. Take a few relaxed breaths,
drop your shoulders, and straighten your back. Or, pick up a piece of paper, pretend to read it,
but actually just focus on one word on the page as you take several relaxed breaths. You can
also try standing by a window, daydreaming about being in a special place far away from here,
while relaxing your breath and body for a few moments.
3) Five minute breathing break: Sit in a comfortable position; close your eyes and direct attention to the breath. Take smooth, diaphragmatic breaths. Think about nothing but the air flowing in and out of your body. As you inhale, say "Relax." As you exhale, say "Let go." After 5 minutes, stand up, stretch, and smile
Managing Medical Symptoms
Session Three Summary
Thoughts, Attitudes, and Expectations
Patient Handout
The ways in which we think, talk to ourselves, and decide what we believe have a powerful impact on medical symptoms. There are ways of thinking that make symptoms feel worse, and ways of thinking that make symptoms better. Thinking styles can influence current sensations and perceptions, and create expectations about future experiences. When we pick up new information, it can lead to interpreting old symptoms as new and serious diseases.
Faulty thinking about symptoms
There is a style of thinking that makes symptoms feel worse:
Step 1. You notice a sensation or observation.
Step 2. You form an opinion about what's causing the sensation.
Step 3. You focus attention only on the information that validates your suspicion.
Step 4. You stop trying to find alternative explanations.
Step 5. You respond and behave according to what you believe is causing the symptom.
Step 6. Since the belief about the cause was inaccurate to begin with, the response, does not help
the problem; anxiety and distress increase. You miss the chance to reassure yourself and move „
away from the sensation.
Step 7. Now you feel worse than when you first noticed the symptom!
How to change thoughts and beliefs
Step 1. Learn more about the ordinary causes of bodily sensations that are not related to serious
disease.
Step 2. Pick a few alternative explanations for your symptoms based on normal body
functioning or stress.
Step 3. Begin to think and talk to yourself in more reassuring ways.
Taking Risks
Step 1. Remind yourself of what you will gain by taking this risk, what the reward will be.
Step 2. Remember other risks you've taken that are now second nature to you.
Step 3. Face whatever it is that you are afraid of. Be realistic about the chances of your worst
fear happening. Use relaxation skills to stay calm and focused. Fear is not meant to be a wall,
it's meant to be a door that you can open and pass through!
Step 4. Break the change into small steps to take one at a time.
Step 5. Rehearse what to say or do with a friend in advance.
Step 6. After you take the risk, ask yourself how it went, what you will do the same or
differently next time. Focus on identifying the positive consequences. Give yourself a pat on the
back for the effort.
Stress and medical symptoms
One of the main benign explanations of physical symptoms is stress. The stress response is designed to prepare the body and mind to be faster and stronger in an emergency. If you are not in a genuine emergency, you might experience the physical changes as uncomfortable and alarming sensations-i.e.- the heart pumps faster, breathing rate increases, muscle tension increases, the mind speeds up to process information. Remember that the brain does not differentiate between an event that is actually happening and an event that we are remembering or anticipating. Even if you are imagining a "worst case scenario" that never actually happened, the stress response will be triggered if you perceive those thoughts as stressful and beyond your coping ability.
***How to make this information work for you***
Think about your target symptom. What do you usually attribute the symptom to? Write down 2 or 3 alternative causes based on stress signals or normal bodily functions. Repeat these attributions to yourself when you're concerned about the symptom. Notice when the symptom seems to feel better or worse. What's going on at that time? What's on your mind?
Pick a change you feel ready to make, consider the risk involved. Think through the steps
involved above. Then try it out!
Managing Medical Symptoms
Patient Handout: Stress Signals
Session Three
The stress response can be manifested in many personal as well as common ways. It is beneficial to learn your own typical response, and to be familiar with the range of stress signals. Some of these signals are also associated with causes other than stress, and any persistent or severe symptom should be evaluated by a physician.
Fast heartbeat Palpitations
Nervous tics and motions
Flushing
Sweating
Rash/hives
Weakness
Insomnia/sleep disturbance
Physical Signals
Muscle tightness
Tension headache Dry mouth
Gastrointestinal problems
Startled reaction Chest tightness Fatigue
Dizziness
Behavioral Signals
Overuse of alcohol Arguing Teeth grinding
Smoking
Overeating
Clumsiness/ accident prone
Nervousness/ anxiety
Irritability/ anger
Forgetfulness/ disorganization
/Frustration
Insecurity/ self-criticism Sharp mood swings Loss of sense of humor
Emotional and Cognitive Signals
Agitation Distractibility Nightmares Ruminative thoughts Poor concentration
Managing Medical Symptoms Session Four Summary
Patient Handout Context and Perspective
Physical symptoms are produced in certain conditions that promote selective attention to bodily sensations. It takes a considerable amount of detective work to identify the context of your most troublesome symptoms. However, the reward is worth the effort. You can modify physical symptoms by modifying the conditions that amplify your symptoms.
Some of the factors that make up context include environmental factors, relationships with people in the situation, stress, expectations, conditioned habits, and the limitations of medical knowledge and treatment. These factors tend to direct our attention to our bodies, make us suspect that we may be ill, and interpret bodily discomfort as symptomatic of disease. This leads to the amplification effect on the original symptom- the symptom seems bigger, louder, and more ominous than before. For example, if you wake up with a mild headache on vacation, you might say^This will go away as soon as I have a good breakfast and a walk in the fresh air." If you wake up with the same headache on the day you have to give a speech at work, you might say "Oh no! Now I won't be able to concentrate, I'll be more nervous during the speech, and I'll probably pop a blood vessel from the pressure. Forget that promotion!"
Circumstances, settings, and situation can increase or decrease bodily discomfort by providing clues we use to interpret what we are feeling now, and how we can expect to feel in the future. For example, when your son has a cold and you sneeze, you might assume you've caught his cold and will have to miss your friend's cook-out next weekend
Our expectations of treatment have a powerful effect on how we perceive present and future symptoms. Expecting a symptom to vanish with treatment may make its persistence worse than if you had never expected relief in the first place. Hearing that a benign symptom "just has to run its course," or that there is nothing else a doctor can do, can make the discomfort worse until you decide to ignore the symptom as much as possible.
Interpersonal factors have a major influence on symptom perception. When you feel that a family member is not sympathetic to your symptoms, it can add pressure to prove how sick you really are. In the opposite situation, when a family member is overly concerned and solicitous, it can make it harder to move away from seeing yourself as a "sickly person" or "weak." It is helpful to pay attention to which communication styles and responses make your symptoms better or worse.
Healthy attitudes toward symptoms
Living with chronic, benign conditions is less disruptive when you adopt a certain constructive
mindset.
Step 1. Accept that the condition may be chronic, and there are limits to effective treatment.
Turn your efforts towards coping with symptoms rather than eliminating them.
Step 2. Make a conscious decision to control the condition as much as possible, rather than
letting it control your quality of life. Avoid or modify the triggers that make symptoms worse.
Step 3. Follow through with effective self-management strategies.
Step 4. Reduce the stress in your life as much as possible.
Managing Medical Symptoms Session Four Summary
Patient Handout Context and Perspective
Physical symptoms are produced in certain conditions that promote selective attention to bodily sensations. It takes a considerable amount of detective work to identify the context of your most troublesome symptoms. However, the reward is worth the effort. You can modify physical symptoms by modifying the conditions that amplify your symptoms.
Some of the factors that make up context include environmental factors, relationships with people in the situation, stress, expectations, conditioned habits, and the limitations of medical knowledge and treatment. These factors tend to direct our attention to our bodies, make us suspect that we may be ill, and interpret bodily discomfort as symptomatic of disease. This leads to the amplification effect on the original symptom- the symptom seems bigger, louder, and more ominous than before. For example, if you wake up with a mild headache on vacation, you might say^This will go away as soon as I have a good breakfast and a walk in the fresh air." If you wake up with the same headache on the day you have to give a speech at work, you might say "Oh no! Now I won't be able to concentrate, I'll be more nervous during the speech, and I'll probably pop a blood vessel from the pressure. Forget that promotion!"
Circumstances, settings, and situation can increase or decrease bodily discomfort by providing clues we use to interpret what we are feeling now, and how we can expect to feel in the future. For example, when your son has a cold and you sneeze, you might assume you've caught his cold and will have to miss your friend's cook-out next weekend
Our expectations of treatment have a powerful effect on how we perceive present and future symptoms. Expecting a symptom to vanish with treatment may make its persistence worse than if you had never expected relief in the first place. Hearing that a benign symptom "just has to run its course," or that there is nothing else a doctor can do, can make the discomfort worse until you decide to ignore the symptom as much as possible.
Interpersonal factors have a major influence on symptom perception. When you feel that a family member is not sympathetic to your symptoms, it can add pressure to prove how sick you really are. In the opposite situation, when a family member is overly concerned and solicitous, it can make it harder to move away from seeing yourself as a "sickly person" or "weak." It is helpful to pay attention to which communication styles and responses make your symptoms better or worse.
Healthy attitudes toward symptoms
Living with chronic, benign conditions is less disruptive when you adopt a certain constructive
mindset.
Step 1. Accept that the condition may be chronic, and there are limits to effective treatment.
Turn your efforts towards coping with symptoms rather than eliminating them.
Step 2. Make a conscious decision to control the condition as much as possible, rather than
letting it control your quality of life. Avoid or modify the triggers that make symptoms worse.
Step 3. Follow through with effective self-management strategies.
Step 4. Reduce the stress in your life as much as possible.
Step 5. Distract your mind from ruminative worries with relaxation techniques, distracting
activities, and pleasurable activities.
Step 6. Participate in the activities that give you satisfaction as often as possible.
***How to make this information work for you***
Consider what you've already learned in this program about the times and places that draw your attention to your symptom, and make it feel worse. Take it a step further by going through the "5 W's"- who, why, what, when, and where. You might also find it useful to consider the attitudes and behaviors of family members and coworkers. Is there anything they do that makes you aware of feeling like a "sick person" or a "healthy person?"
If you could change one stressful situation or interaction, what would it be? It is more realistic to change ourselves rather than trying to change other people. Think of ways to start to change your part in this situation. It might mean changing your perspective, the way you think about the situation, how you act in the situation, or making actual changes in the circumstances. Now is your chance to take positive action to change the context and change your symptom!
Managing Medical Symptoms
Session Four
Cognitive Restructuring
Patient Handout
Cognitive Restructuring is a technique to change the thoughts that make the symptom more serious than it actually is to thoughts that put the symptom in a more realistic perspective and help you to reassure yourself.
Monitor your thoughts to track negative and catastrophic automatic thoughts. 2. Recognize the emotional and physical responses that follow the thought.
Step 3. Develop rational, countering statements for each troublesome thought. These statements are based on realistic, alternative explanations. Try writing the worrisome thought on one side of an index card, and the rational thought on the other side of the card. Keep the cards with you to practice whenever the negative thoughts come up.
Step 4. Each time the negative thought occurs, replace it with the rational thought. Notice the change in physical and emotional responses when you use the countering thoughts.
Step 5. Practice, practice, practice! Each time you catch yourself focusing attention on a familiar, benign symptom, notice the thoughts. Then challenge distressing beliefs with reassuring statements. Remember, the thoughts and self-talk that are repeated the most are
the ones that determine how bad a symptom feels and emotional distress!
***How to make this information work for you***
Practice cognitive restructuring starting with a negative automatic thought you hear yourself thinking often. Make yourself a booster pack of index cards. On one side write the automatic thought you want to change. On the other side, write the new, rational thought you plan to substitute. Remember, we believe what we tell ourselves, so make your thoughts contribute to feeling better!
Managing Medical Symptoms
Session Five Summary
Patient Handout
Behavior
Setting Goals and Changing Health Behaviors
There are two main types of change involved in coping more effectively with medical symptoms:
1) Starting or resuming activities that pose no threat to health.
2) Eliminating behaviors that bring on symptoms or keep them present.
1) Starting or resuming activities.
We learned in an earlier session that changing self-limiting beliefs involves convincing yourself that a guiding belief is not true. There's no better way to convince yourself than by behavioral demonstration! A major coping strategy is to maintain an active and involved lifestyle while pacing yourself wisely. Identify an activity that you enjoyed before your symptoms became problematic, and" that you assume makes the symptom worse. Plan a realistic way to resume the activity at a lower level or slower pace than in the past. For instance, if you think walking to the store brings on fatigue, plan to walk about half as far as you used to as you rebuild strength. Take note of how your symptom feels before and after the walk. Remind yourself that avoiding exercise is more likely the cause of tiredness than being active.
Every day, seek out pleasurable activities that allow you to take time for yourself, reduce stress, and boost energy. Pleasurable activities have been proven to be good medicine!
2) Eliminating behaviors that perpetuate symptoms
Thoughtfully consider the behaviors that have been shown to trigger or fuel symptoms, as well as your observations about behaviors that contribute to you feeling sick. Select one behavior you'd like to eliminate, and develop an alternative approach to the situation. For instance, you could try not reading medical articles for one week. If you check in on your pain level every 15 minutes, you could try only rating it at the top of the hour. Notice how bothersome your symptom feels on a scale of 1-10 with the old, familiar behavior and after practicing the new behavior.
***How to make this information work for you***
You came to this program because you were interested in learning new ways to reduce medical symptoms and make them easier to live with. Having a personal goal makes the information more applicable and customized for you. Before setting a goal, take some time to figure out which of your behaviors fuel your symptom. You can decide to either resume an important activity or to eliminate a behavior that has become counterproductive. Then set your goal. Goals work best when they are phrased in a positive way, describe one specific behavior, and are measurable. Here are the steps:
Step 1. Select a long-term goal - what you want to be doing in 6 months
Step 2. Break the long-term goal down into short-term goals - steps you can take over the next
few weeks and months.
Step 3. Plan rewards to reinforce your progress and celebrate the healthy changes you are
making.
Step 4. Be patient and determined about reaching your goal. Practice a short-term step daily.
Plan rewards to reinforce your progress, and celebrate the healthy changes you are making.
Step 5. Everyone slips once in awhile. Make sure the goal is realistic, figure out how to avoid
the slip next time, then go back to your plan.
Here's an example. Martha has been worried about developing Alzheimer's disease since her mother-in law was diagnosed with early Alzheimer's last year. Martha has been under stress from taking care of Mildred, and withdrew from her friends and weekly dinners out. Martha scans her mind often, and worries about her lack of concentration, and forgetting little details she used to do automatically.
She also complained of pain in her shoulders and neck, and headaches three times a week. Martha's physician has reassured her that her neurological tests are normal, that she has no personal family history of Alzheimer's, and that her symptoms are from ongoing stress.
Finally Martha decides something has to give, and that her worrying is making her feel sick.
She decides to test out the stress theory by setting a goal of going out with her friend Betty every
Thursday night as a break from her caregiver responsibilities. On the first Thursday, Martha
feels tired and muddled after a busy day with Mildred, but determined to shift her thoughts to
pleasant topics. She and Betty enjoy a leisurely dinner, and share some laughs about their
children's antics. When Martha returns home, she notices that her mood is lighter, and she can
remember the highlights of the evening clearly. So, a goal is born!
Long- term goal: "I will go out to dinner with a friend once a week."
Short-term goals:
1. I will start taking 20 minutes for myself every day - to listen to music, stretch, telephone a
friend, take a walk.
2.1 will find a family member to stay with Mildred on Thursday nights.
Within a month Martha realized that when she started worrying about her memory it was a signal that she was stressed out and needed to pay more attention to herself. When she did so, her mind became refocused and calmer. She also felt less tense and had fewer headaches.
Managing Medical Symptoms
Session Five Summary
Patient Handout
Behavior
Counterproductive Health Behaviors
There are several behaviors that can potentially heighten health concerns and make symptoms worse. These behaviors include:
1) Avoiding usual activities and treating yourself like a sick person.
2) Excessively examining yourself and seeking medical tests.
3) Excessively seeking reassurance from a range of people and frequent medical appointments.
4) Excessively searching medical conditions in the media, or using the Internet World Wide Web.
These behaviors become counterproductive because they are undertaken to reduce anxiety, but eventually they increase anxiety and symptom perception.
1) Avoiding usual activities
Avoidance increases anxiety because the person incorrectly assumes that a particular activity caused his symptom, then avoids it to protect himself. However, since the activity did not cause the symptom, limiting the activity only leads to more problems.
Limiting activities like a sick person means you never get a chance to prove your original idea wrong, and move on with life.
2) Excessively examining yourself and seeking tests
Focusing attention on a sensation intensifies the sensation, and we exacerbate the irritation by the action we think will relieve it. For instance, feeling a lymph node you think is swollen over and over will bruise the tissue and make the node more tender. Anxiety increases along with the suspicion that there is a tumor, and the cycle continues.
Many people believe the only way to rule out a problem is with a test, and that positive test results are reliable, but negative test results are suspicious. This leads to requesting more tests, risking adverse reactions to the tests, and not feeling reassured anyway. Anxiety about having a serious illness lingers.
3) Excessively seeking frequent reassurance
People seek reassurance in many direct and indirect ways. They often notice that they feel reassured for awhile, but then the doubts about how they presented their story set in and anxiety replaces reassurance. They're back where they started from, but even more worried and convinced they are really sick. You can get whatever information you are looking for to confirm a belief if you look hard enough!
4) Researching medical symptoms
_ While we need to be informed health care consumers, there is a limit to the type and amount of
information that is beneficial. Remember "medical student syndrome," where medical students
become very anxious about new diseases they are studying, and begin to attribute long-standing
normal sensations to this new disease. Soon they're in the student health clinic, convinced they have a horrible illness. Instead of looking up symptoms and gathering an array of unlikely causes, start by looking at common sense factors that you can control. If the symptom persists, report it to your doctor.
Beware of being swept up in newspaper and television reports on specific illnesses. Having only seconds to report on the condition can yield a sensationalistic tone and make the condition sound more common and threatening than it actually is.
Managing Medical Symptoms
Pleasant Events Suggestions
(Adapted from Skills Training Manual by Marsha Linehan)
Session Five Patient Handout
1. Soak in the bathtub
2. Collect things
3. Plan a vacation
4. Take a day off
5. Arrange flowers
6. Practice religion
7. Go to a movie in the middle of the week
8. Get together with friends
9. Doodle, paint, needlepoint
10. Think "I'm an OK person."
11. Jog, walk, hike
12. Go camping, to the beach, fishing
13. Listen to music
14. Lie in the sun
15. Play with animals
16. Play a musical instrument
17. Go out for coffee, lunch
18. Join a club, or group
19. Buy clothes
20. Hobbies
21. Make a gift for someone
22. Meet new people
23. Go to the beauty salon
24. Remember beautiful scenery
25. Go to a play, concert, movie
26. Spend money on yourself
27. Complete a task
28. Think about pleasant events
29. Repair something
30. Play with children
31. Remember kind words
32. Take care of plants, gardening
33. Swim
34. Help out in the community
35. Think "I am a person who can cope!"
COMMON DISTORTIONS OF THINKING
1. JUMPING TO CONCLUSIONS e.g., The Dr. prescribed an antipsychotic medication. I must be psychotic.
2. GENERALIATION e.g. A. Everybody is better off than me. B. I'm different from everybody else. C. My last boyfriend/girlfriend lied to me. You can't trust men/women)
3. FORTUNE TELLING: What if,? Etc. Predicting the future, e.g. I am going to be just like my mother's aunt Sally. What if this medication makes me worse?
4. THINKING IN EXTREMES: e.g. I am right and he is wrong. Saying: " I hate you!", instead of saying: "Sometimes I dislike the way you behave.
CHALLENGE YOUR THOUGHTS
1 .First Identify Them (Observe them as uncritically as possible
2.Do Not Identify With Them (You did not create them).
Do your thoughts represent an accurate picture of reality as you know it, Qf is it a ••distortion ?
Come up with a more realistic thouaht
Managing Medical Symptoms
Session Six Summary
Patient Handout
Moods
Certain emotions and moods affect physical symptoms for two main reasons:
1) Anxiety, depression, and stress can intensify bodily symptoms because emotional states cause changes in the major systems of the body - the nervous, cardiovascular, and endocrine systems. These sensations can be easily misinterpreted to mean that new medical problems have arisen.
2) Mood can also change how you evaluate bodily sensations, and how you think about health and illness.
Anxiety
Anxiety is a state of being on the lookout for both internal and external threats. Anxious people
expect harm, and pay selective attention to observations they perceive as dangerous and
threatening.
The physical effects of anxiety include increased heart rate, muscle tension, sweating, flushing, dry mouth, stomach churning, lower pain threshold and tolerance. Anxious people are more tuned in to bodily sensations, and when these anxiety-induced changes are added, they think new and ominous conditions are developing.
Depression
Depressed people may feel defective, punished, or damaged in some way. They dwell on
negative memories, and focus on suffering and death. Depressed people are preoccupied with
internal processes, and mistake symptoms of depression for symptoms of dire illness.
Depression can cause physical changes such as low energy, trouble sleeping, appetite changes,
and constipation.
Stress
Stress also causes dramatic changes in the body, which can become alarming if you're not aware that stress is the culprit. Refer back to the handout from Session Three on stress signals. It is important to take time to identify and modify the source of stress and how you are responding.
***How to make this information work for you***
Stop every so often and ask yourself how am I feeling? How has my mood been lately? What's been on my mind? When we don't make the time to pay attention to how we're feeling, the mind and body work together to get our attention! There are some strategies you can use to feel better when anxious or mildly depressed.
Reducing Anxiety
Practice relaxation with your audiotape or relaxing music; do a brief relaxation; get some
exercise or do some stretches; take direct action to solve something that you are worried about;
use distraction techniques to get away from worries and sensations; use the thought stopping
technique; keep your thoughts in the present moment; engage in a pleasurable activity; postpone
worrying until an appointed time later in the day.
Lifting Depression
in a
Mild depression often lightens when you take action or control of a situation; get up, showered and dressed even if you don't feel like it; get exercise or go for a walk; plan a structured, enjoyable activity to look forward to every day; challenge negative thoughts; have a structured, enjoyable activity to look forward to every day; reach out and talk to a friend about problems; get out of the house and be around people; watch a comedy movie; get involved with others in common project; do something that makes you feel good about yourself.
MANAGING MEDICAL SYMPTOMS READING LIST
Stress Management and Relaxation
Minding the Body, Mending the Mind. Joan Borysenko. Bantam, 1988.
The Wellness Book. Herbert Benson and Eileen Stuart. Simon & Schuster/Fireside, 1992
The Woman's Comfort Book. Jennifer Louden. Harper SanFrancisco, 1992.
The Stress Solution-An Action Plan to Manage the Stress in Your Life. Lyle Miller and Alma
Dell Smith. Pocket Book, 1993.
Wellness at Work-Building Resilience to Job Stress. Valerie O'Hara. New Harbinger
Publications, 1995.
Wellness and Symptom Management
Stop Suffering Now. Arthur J. Barsky and Emily C. Deans. HarperCollins, 2005.
Managing Pain Before It Manages You. Margaret Caudill. Guilford Press, 1995.
Healing Mind, Healthy Woman. Alice Domar and Henry Dreher. Henry Holt & Co, 1996.
Living a Healthy Life with a Chronic Condition. Kate Lorig, Holstead Holman. Bull Publishing
Co, 1994.
The Healthy Mind Healthy Body Handbook. David Sobel and Robert Ornstein.
HarperCollins, 1996.
It's Not All in Your Head. Gordon JG Asmundson and Steven Taylor. Guilford Press, 2005
Stop worrying About your Health! George Zgourides. Oakland, CA: New Harbinger
Publications, 2002
Back Sense. Ronald D. Siegel, Michael H. Urdang, Douglas R. Johnson. Broadway Books,
2001.
The Feeling Good Handbook. David Burns. Penguin, 1989.
Mind Over Mood. Dennis Greenberger and Christine Padesky. Guilford Press, 1995.
Session One Summary Patient Handout: Shifting Attitudes
1) Old Attitude: Every symptom has a definitive medical explanation.
New Attitude: Many symptoms have no clear cause, or definitive medical explanation. This does not mean they are grave or life threatening.
2) Old Attitude: Somewhere there is a doctor who can cure my symptoms.
New Attitude: There comes a point where I can choose to stop seeking a medical explanation and cure, accept that my symptoms may not go away, and start to learn to cope with my symptoms.
3) Old Attitude: Unless I get rid of my symptoms completely, I won't feel any better at all.
New Attitude: I can decrease discomfort and improve the quality of my life by changing my beliefs, assumptions, and feelings about my symptoms. I can learn to interpret symptoms in non-frightening and more realistic ways.
4) Old Attitude: Good health means being symptom free. So, if something is wrong, it must be a disease.
New Attitude: Even healthy people experience sensations and symptoms regularly. Many symptoms are caused by normal bodily changes in response to activity, stress, emotions, and other benign causes. I can learn to accurately label these sensations then ignore them.
The way in which I interpret and think about sensations and symptoms greatly influences how intense and disturbing they seem. The more threatening I believe the cause to be, the more I will experience the symptom as painful. Symptoms I believe to have "normal" causes will seem much less intense than symptoms I attribute to disease.
5) Old Attitude: If my doctor has not found a cure for me yet, he/she must not be that concerned about me or my medical problems.
New Attitude: My doctor takes my concerns seriously, and wants me to feel better. However, there are limits to medical knowledge, and not all symptoms have known cures. There are other ways to cope with these symptoms effectively, even if they cannot be cured.
***How to make this information work for you***
Consider how each attitude might apply to your target symptom. Is there an attitude that contributes to your distress and that you now feel ready to challenge? Select one of the new attitudes to start practicing with your symptoms. Be patient as you test it out several times and reinforce the new belief.
Managing Medical Symptoms
DIAPHRAGMATIC BREATHING
Session One Patient Handout
Points of Emphasis
1) You can practice diaphragmatic breathing in a seated or lying position. Eventually you will be able to use relaxed breathing even while standing or moving. Choose a position with your back supported and straight, avoid being bent at the waist. Wear loose clothing so your waist and abdomen can expand freely.
2) Practice diaphragmatic breathing for ten minutes twice a day to start. Practice the diaphragmatic breathing technique for a few minutes, take a break to breath as you normally do, then return to a few minutes of diaphragmatic breathing. You do not need to do the ten minutes continuously in the beginning.
3) If you feel dizzy or lightheaded, or you feel tingling in your lips or fingertips, stop practicing and go back to your regular way of breathing until those sensations pass. Review the instructions before your next practice session, and take care to avoid hyperventilating or overbreathing.
Diaphragmatic Breathing Instructions
1) Choose a comfortable position, and loosen any tight clothing. Relax the muscles of your shoulders, back, and chest. Most important, relax your belly, so it can expand with each breath.
2) Breathe in through your nose to warm and filter the air. Breathe out through your mouth, with lips pursed to hold the air passages open longer. Once you are comfortable with this technique, you can inhale and exhale through your nose.
3) Place your hand lightly on your abdomen, just above the navel.
4) Exhale slowly through pursed lips while gently pressing on your abdomen. This empties the lungs, and makes room to inhale fresh air.
5) Now begin the cycle: inhale slowly and easily through the nose. Pause for a second. Now exhale slowly and completely through the mouth with lips pursed. It may take longer than you expect! It takes about twice as long to exhale as it does to inhale. Pause, then begin the next cycle as your body begins to inhale. Take all the time you need for each breath in, and each breath out.
6) It may take several breaths before you feel your breath flowing easily and deeply. You will begin to feel your hand rise about an inch or so when you inhale, and then fall every time you exhale. Inhale, belly rises and hand rises; exhale, belly falls, hand lowers. Your aim is to settle into a smooth, even rhythm. Don't worry about moving large amounts of air in and out of your lungs. The even, rhythmic flow is more important.
Try A Mental Focus
Once you have the basic movements down, you might like to add a mental focus. Experiment
with a few different types of mental focus techniques to see which one you prefer.
1) Imagine that there is a balloon right behind your navel. As you inhale, the balloon inflates,
your belly expands out. As you exhale, the balloon deflates, your belly flattens as the air flows
out.
2) You might like to imagine your breath flowing like the gentle waves of the ocean, flowing into the shore and then flowing back out again... a smooth, even rhythm, very soothing and relaxing.
3) You can repeat a phrase with each breath. For example, inhale, exhale and say "relax" or "let go."
4) Count from one to four as you inhale, then from one to four as you exhale.
Be patient and keep up your practice! If you have questions, bring them to the next session.
Managing Medical Symptoms
Session Two Summary
Patient Handout
Attention
Attention is one of the main influences on how we feel physically. The amount of attention we pay to symptoms influences how intense the symptoms feel. The more attention we direct to a symptom, the more it hurts or bothers us. For example, banging your shin on a chair while you are home alone will be more painful than banging your shin while skiing with friends. In the latter case, you would be distracted by having fun and being with friends so you would hardly notice the injury. While home alone, you would focus intently on the painful sensation and blossoming bruise.
Attention is also one of the main influences on how we feel emotionally. Focusing on a symptom raises your anxiety level. The more one focuses, the more serious and worrisome the symptom becomes. When intense attention is combined with anxiety, physical changes take place that make it seem that the symptom is getting worse, even though the cause of the symptom remains the same.
Just as increasing the attention you give a symptom increases sensitivity and discomfort,
lessening the attention you pay will lessen discomfort. Distraction is an effective way to shift
your attention away from unpleasant physical sensations and worrisome thoughts.
Many people have developed a fine-tuned sensitivity to what goes on inside their body. This sensitivity contributes to unpleasant sensations and worry. The good news is that the same sensitivity will make it easier for you to learn relaxation. Relaxation training helps reduce stress and anxiety.
***How to make this information work for you***
Select a symptom that has been checked out by your doctor and for which no serious cause has
been found. Rate the symptom on a scale of 1-5, with 5 being most bothersome. For five
minutes, focus intently on the symptom, imagining the cause and what is going on inside. Let
the worried thoughts you often have come in. Then rate the symptom from 1-5 again. Which
direction did your rating go? .
Now select a distraction technique, and practice it for 10 minutes. Rate your symptom one last
time. Did your ratings change?
When you notice yourself focusing attention on a symptom, take a break to practice relaxation or to distract your attention. The goal is to break the cycle of symptom perception by reducing attention, anxiety, and the frightening meaning attached to the symptom. Even if the symptom doesn't go away, you will feel more in control and less bothered.
Managing Medical Symptoms
Session Two
Patient Handout: Distraction Techniques
Distraction can redirect conscious awareness away from bothersome sensations and repeated
worries. A number of techniques are described below, but any constructive, absorbing activity is
a good choice.
1) Go through the alphabet, naming varieties of soup, i.e., A = asparagus, B = bean, C = cream of mushroom. Name all 50 States.
2) Do a simple task such as washing dishes, watering plants, fix something. Give the activity your full attention.
3) Spend time on an enjoyable craft project: knitting, needlepoint, woodworking, stringing beads. Write in a journal, draw, doodle, or paint.
4) Focus on the outside world. Stand by a window and count the cars going by. Describe the changes you notice in your garden or front yard since last week.
5) Replay a happy moment in your memory as if watching a movie. Use all your senses to make the scene come alive, i.e., try to imagine the temperature, the sounds around you, the quality of the light, a breeze, etc.
6) Try rhythm. Sing along with the radio, drum with your fingers, recite poetry, or pet a cat.
7) Concentrate on planning an activity you are looking forward to.
8) Games are a great distraction: computer games, cards, crossword puzzle, word games.
9) Telephone someone who has a good sense of humor. Deliberately avoid talking about
symptoms or health. .
10) Take a warm bath or shower. Focus on the scent of the soap, the comfort of a fluffy towel. Make it a pleasurable experience.
11) Exercise or take a walk.
12) Massage your face/neck/hands/shoulders/feet with fragrant lotion.
Managing Medical Symptoms
Patient Handout: Brief Relaxations
Session Two
Brief relaxations are additional ways to use the diaphragmatic breathing technique to give you the opportunity to reduce bodily hyperarousal, step away from a stresso^ and refocus on a healthier perspective. Brief relaxations work best when scheduled into your day at frequent intervals, every 1-2 hours.
These relaxations are easy to do even if you are new to relaxation:
1) Countdown breathing: Close your eyes or gaze softly at the floor. Take a breath in, and as you exhale, say "Ten." Take another breath in, a little slower and deeper. As you exhale, say "Nine." Continue counting down to zero with each breath. Feel the tension draining out of your body with each exhalation.
2) At work in a busy office, pick up a telephone and put it on hold. Take a few relaxed breaths,
drop your shoulders, and straighten your back. Or, pick up a piece of paper, pretend to read it,
but actually just focus on one word on the page as you take several relaxed breaths. You can
also try standing by a window, daydreaming about being in a special place far away from here,
while relaxing your breath and body for a few moments.
3) Five minute breathing break: Sit in a comfortable position; close your eyes and direct attention to the breath. Take smooth, diaphragmatic breaths. Think about nothing but the air flowing in and out of your body. As you inhale, say "Relax." As you exhale, say "Let go." After 5 minutes, stand up, stretch, and smile
Managing Medical Symptoms
Session Three Summary
Thoughts, Attitudes, and Expectations
Patient Handout
The ways in which we think, talk to ourselves, and decide what we believe have a powerful impact on medical symptoms. There are ways of thinking that make symptoms feel worse, and ways of thinking that make symptoms better. Thinking styles can influence current sensations and perceptions, and create expectations about future experiences. When we pick up new information, it can lead to interpreting old symptoms as new and serious diseases.
Faulty thinking about symptoms
There is a style of thinking that makes symptoms feel worse:
Step 1. You notice a sensation or observation.
Step 2. You form an opinion about what's causing the sensation.
Step 3. You focus attention only on the information that validates your suspicion.
Step 4. You stop trying to find alternative explanations.
Step 5. You respond and behave according to what you believe is causing the symptom.
Step 6. Since the belief about the cause was inaccurate to begin with, the response, does not help
the problem; anxiety and distress increase. You miss the chance to reassure yourself and move „
away from the sensation.
Step 7. Now you feel worse than when you first noticed the symptom!
How to change thoughts and beliefs
Step 1. Learn more about the ordinary causes of bodily sensations that are not related to serious
disease.
Step 2. Pick a few alternative explanations for your symptoms based on normal body
functioning or stress.
Step 3. Begin to think and talk to yourself in more reassuring ways.
Taking Risks
Step 1. Remind yourself of what you will gain by taking this risk, what the reward will be.
Step 2. Remember other risks you've taken that are now second nature to you.
Step 3. Face whatever it is that you are afraid of. Be realistic about the chances of your worst
fear happening. Use relaxation skills to stay calm and focused. Fear is not meant to be a wall,
it's meant to be a door that you can open and pass through!
Step 4. Break the change into small steps to take one at a time.
Step 5. Rehearse what to say or do with a friend in advance.
Step 6. After you take the risk, ask yourself how it went, what you will do the same or
differently next time. Focus on identifying the positive consequences. Give yourself a pat on the
back for the effort.
Stress and medical symptoms
One of the main benign explanations of physical symptoms is stress. The stress response is designed to prepare the body and mind to be faster and stronger in an emergency. If you are not in a genuine emergency, you might experience the physical changes as uncomfortable and alarming sensations-i.e.- the heart pumps faster, breathing rate increases, muscle tension increases, the mind speeds up to process information. Remember that the brain does not differentiate between an event that is actually happening and an event that we are remembering or anticipating. Even if you are imagining a "worst case scenario" that never actually happened, the stress response will be triggered if you perceive those thoughts as stressful and beyond your coping ability.
***How to make this information work for you***
Think about your target symptom. What do you usually attribute the symptom to? Write down 2 or 3 alternative causes based on stress signals or normal bodily functions. Repeat these attributions to yourself when you're concerned about the symptom. Notice when the symptom seems to feel better or worse. What's going on at that time? What's on your mind?
Pick a change you feel ready to make, consider the risk involved. Think through the steps
involved above. Then try it out!
Managing Medical Symptoms
Patient Handout: Stress Signals
Session Three
The stress response can be manifested in many personal as well as common ways. It is beneficial to learn your own typical response, and to be familiar with the range of stress signals. Some of these signals are also associated with causes other than stress, and any persistent or severe symptom should be evaluated by a physician.
Fast heartbeat Palpitations
Nervous tics and motions
Flushing
Sweating
Rash/hives
Weakness
Insomnia/sleep disturbance
Physical Signals
Muscle tightness
Tension headache Dry mouth
Gastrointestinal problems
Startled reaction Chest tightness Fatigue
Dizziness
Behavioral Signals
Overuse of alcohol Arguing Teeth grinding
Smoking
Overeating
Clumsiness/ accident prone
Nervousness/ anxiety
Irritability/ anger
Forgetfulness/ disorganization
/Frustration
Insecurity/ self-criticism Sharp mood swings Loss of sense of humor
Emotional and Cognitive Signals
Agitation Distractibility Nightmares Ruminative thoughts Poor concentration
Managing Medical Symptoms Session Four Summary
Patient Handout Context and Perspective
Physical symptoms are produced in certain conditions that promote selective attention to bodily sensations. It takes a considerable amount of detective work to identify the context of your most troublesome symptoms. However, the reward is worth the effort. You can modify physical symptoms by modifying the conditions that amplify your symptoms.
Some of the factors that make up context include environmental factors, relationships with people in the situation, stress, expectations, conditioned habits, and the limitations of medical knowledge and treatment. These factors tend to direct our attention to our bodies, make us suspect that we may be ill, and interpret bodily discomfort as symptomatic of disease. This leads to the amplification effect on the original symptom- the symptom seems bigger, louder, and more ominous than before. For example, if you wake up with a mild headache on vacation, you might say^This will go away as soon as I have a good breakfast and a walk in the fresh air." If you wake up with the same headache on the day you have to give a speech at work, you might say "Oh no! Now I won't be able to concentrate, I'll be more nervous during the speech, and I'll probably pop a blood vessel from the pressure. Forget that promotion!"
Circumstances, settings, and situation can increase or decrease bodily discomfort by providing clues we use to interpret what we are feeling now, and how we can expect to feel in the future. For example, when your son has a cold and you sneeze, you might assume you've caught his cold and will have to miss your friend's cook-out next weekend
Our expectations of treatment have a powerful effect on how we perceive present and future symptoms. Expecting a symptom to vanish with treatment may make its persistence worse than if you had never expected relief in the first place. Hearing that a benign symptom "just has to run its course," or that there is nothing else a doctor can do, can make the discomfort worse until you decide to ignore the symptom as much as possible.
Interpersonal factors have a major influence on symptom perception. When you feel that a family member is not sympathetic to your symptoms, it can add pressure to prove how sick you really are. In the opposite situation, when a family member is overly concerned and solicitous, it can make it harder to move away from seeing yourself as a "sickly person" or "weak." It is helpful to pay attention to which communication styles and responses make your symptoms better or worse.
Healthy attitudes toward symptoms
Living with chronic, benign conditions is less disruptive when you adopt a certain constructive
mindset.
Step 1. Accept that the condition may be chronic, and there are limits to effective treatment.
Turn your efforts towards coping with symptoms rather than eliminating them.
Step 2. Make a conscious decision to control the condition as much as possible, rather than
letting it control your quality of life. Avoid or modify the triggers that make symptoms worse.
Step 3. Follow through with effective self-management strategies.
Step 4. Reduce the stress in your life as much as possible.
Managing Medical Symptoms Session Four Summary
Patient Handout Context and Perspective
Physical symptoms are produced in certain conditions that promote selective attention to bodily sensations. It takes a considerable amount of detective work to identify the context of your most troublesome symptoms. However, the reward is worth the effort. You can modify physical symptoms by modifying the conditions that amplify your symptoms.
Some of the factors that make up context include environmental factors, relationships with people in the situation, stress, expectations, conditioned habits, and the limitations of medical knowledge and treatment. These factors tend to direct our attention to our bodies, make us suspect that we may be ill, and interpret bodily discomfort as symptomatic of disease. This leads to the amplification effect on the original symptom- the symptom seems bigger, louder, and more ominous than before. For example, if you wake up with a mild headache on vacation, you might say^This will go away as soon as I have a good breakfast and a walk in the fresh air." If you wake up with the same headache on the day you have to give a speech at work, you might say "Oh no! Now I won't be able to concentrate, I'll be more nervous during the speech, and I'll probably pop a blood vessel from the pressure. Forget that promotion!"
Circumstances, settings, and situation can increase or decrease bodily discomfort by providing clues we use to interpret what we are feeling now, and how we can expect to feel in the future. For example, when your son has a cold and you sneeze, you might assume you've caught his cold and will have to miss your friend's cook-out next weekend
Our expectations of treatment have a powerful effect on how we perceive present and future symptoms. Expecting a symptom to vanish with treatment may make its persistence worse than if you had never expected relief in the first place. Hearing that a benign symptom "just has to run its course," or that there is nothing else a doctor can do, can make the discomfort worse until you decide to ignore the symptom as much as possible.
Interpersonal factors have a major influence on symptom perception. When you feel that a family member is not sympathetic to your symptoms, it can add pressure to prove how sick you really are. In the opposite situation, when a family member is overly concerned and solicitous, it can make it harder to move away from seeing yourself as a "sickly person" or "weak." It is helpful to pay attention to which communication styles and responses make your symptoms better or worse.
Healthy attitudes toward symptoms
Living with chronic, benign conditions is less disruptive when you adopt a certain constructive
mindset.
Step 1. Accept that the condition may be chronic, and there are limits to effective treatment.
Turn your efforts towards coping with symptoms rather than eliminating them.
Step 2. Make a conscious decision to control the condition as much as possible, rather than
letting it control your quality of life. Avoid or modify the triggers that make symptoms worse.
Step 3. Follow through with effective self-management strategies.
Step 4. Reduce the stress in your life as much as possible.
Step 5. Distract your mind from ruminative worries with relaxation techniques, distracting
activities, and pleasurable activities.
Step 6. Participate in the activities that give you satisfaction as often as possible.
***How to make this information work for you***
Consider what you've already learned in this program about the times and places that draw your attention to your symptom, and make it feel worse. Take it a step further by going through the "5 W's"- who, why, what, when, and where. You might also find it useful to consider the attitudes and behaviors of family members and coworkers. Is there anything they do that makes you aware of feeling like a "sick person" or a "healthy person?"
If you could change one stressful situation or interaction, what would it be? It is more realistic to change ourselves rather than trying to change other people. Think of ways to start to change your part in this situation. It might mean changing your perspective, the way you think about the situation, how you act in the situation, or making actual changes in the circumstances. Now is your chance to take positive action to change the context and change your symptom!
Managing Medical Symptoms
Session Four
Cognitive Restructuring
Patient Handout
Cognitive Restructuring is a technique to change the thoughts that make the symptom more serious than it actually is to thoughts that put the symptom in a more realistic perspective and help you to reassure yourself.
Monitor your thoughts to track negative and catastrophic automatic thoughts. 2. Recognize the emotional and physical responses that follow the thought.
Step 3. Develop rational, countering statements for each troublesome thought. These statements are based on realistic, alternative explanations. Try writing the worrisome thought on one side of an index card, and the rational thought on the other side of the card. Keep the cards with you to practice whenever the negative thoughts come up.
Step 4. Each time the negative thought occurs, replace it with the rational thought. Notice the change in physical and emotional responses when you use the countering thoughts.
Step 5. Practice, practice, practice! Each time you catch yourself focusing attention on a familiar, benign symptom, notice the thoughts. Then challenge distressing beliefs with reassuring statements. Remember, the thoughts and self-talk that are repeated the most are
the ones that determine how bad a symptom feels and emotional distress!
***How to make this information work for you***
Practice cognitive restructuring starting with a negative automatic thought you hear yourself thinking often. Make yourself a booster pack of index cards. On one side write the automatic thought you want to change. On the other side, write the new, rational thought you plan to substitute. Remember, we believe what we tell ourselves, so make your thoughts contribute to feeling better!
Managing Medical Symptoms
Session Five Summary
Patient Handout
Behavior
Setting Goals and Changing Health Behaviors
There are two main types of change involved in coping more effectively with medical symptoms:
1) Starting or resuming activities that pose no threat to health.
2) Eliminating behaviors that bring on symptoms or keep them present.
1) Starting or resuming activities.
We learned in an earlier session that changing self-limiting beliefs involves convincing yourself that a guiding belief is not true. There's no better way to convince yourself than by behavioral demonstration! A major coping strategy is to maintain an active and involved lifestyle while pacing yourself wisely. Identify an activity that you enjoyed before your symptoms became problematic, and" that you assume makes the symptom worse. Plan a realistic way to resume the activity at a lower level or slower pace than in the past. For instance, if you think walking to the store brings on fatigue, plan to walk about half as far as you used to as you rebuild strength. Take note of how your symptom feels before and after the walk. Remind yourself that avoiding exercise is more likely the cause of tiredness than being active.
Every day, seek out pleasurable activities that allow you to take time for yourself, reduce stress, and boost energy. Pleasurable activities have been proven to be good medicine!
2) Eliminating behaviors that perpetuate symptoms
Thoughtfully consider the behaviors that have been shown to trigger or fuel symptoms, as well as your observations about behaviors that contribute to you feeling sick. Select one behavior you'd like to eliminate, and develop an alternative approach to the situation. For instance, you could try not reading medical articles for one week. If you check in on your pain level every 15 minutes, you could try only rating it at the top of the hour. Notice how bothersome your symptom feels on a scale of 1-10 with the old, familiar behavior and after practicing the new behavior.
***How to make this information work for you***
You came to this program because you were interested in learning new ways to reduce medical symptoms and make them easier to live with. Having a personal goal makes the information more applicable and customized for you. Before setting a goal, take some time to figure out which of your behaviors fuel your symptom. You can decide to either resume an important activity or to eliminate a behavior that has become counterproductive. Then set your goal. Goals work best when they are phrased in a positive way, describe one specific behavior, and are measurable. Here are the steps:
Step 1. Select a long-term goal - what you want to be doing in 6 months
Step 2. Break the long-term goal down into short-term goals - steps you can take over the next
few weeks and months.
Step 3. Plan rewards to reinforce your progress and celebrate the healthy changes you are
making.
Step 4. Be patient and determined about reaching your goal. Practice a short-term step daily.
Plan rewards to reinforce your progress, and celebrate the healthy changes you are making.
Step 5. Everyone slips once in awhile. Make sure the goal is realistic, figure out how to avoid
the slip next time, then go back to your plan.
Here's an example. Martha has been worried about developing Alzheimer's disease since her mother-in law was diagnosed with early Alzheimer's last year. Martha has been under stress from taking care of Mildred, and withdrew from her friends and weekly dinners out. Martha scans her mind often, and worries about her lack of concentration, and forgetting little details she used to do automatically.
She also complained of pain in her shoulders and neck, and headaches three times a week. Martha's physician has reassured her that her neurological tests are normal, that she has no personal family history of Alzheimer's, and that her symptoms are from ongoing stress.
Finally Martha decides something has to give, and that her worrying is making her feel sick.
She decides to test out the stress theory by setting a goal of going out with her friend Betty every
Thursday night as a break from her caregiver responsibilities. On the first Thursday, Martha
feels tired and muddled after a busy day with Mildred, but determined to shift her thoughts to
pleasant topics. She and Betty enjoy a leisurely dinner, and share some laughs about their
children's antics. When Martha returns home, she notices that her mood is lighter, and she can
remember the highlights of the evening clearly. So, a goal is born!
Long- term goal: "I will go out to dinner with a friend once a week."
Short-term goals:
1. I will start taking 20 minutes for myself every day - to listen to music, stretch, telephone a
friend, take a walk.
2.1 will find a family member to stay with Mildred on Thursday nights.
Within a month Martha realized that when she started worrying about her memory it was a signal that she was stressed out and needed to pay more attention to herself. When she did so, her mind became refocused and calmer. She also felt less tense and had fewer headaches.
Managing Medical Symptoms
Session Five Summary
Patient Handout
Behavior
Counterproductive Health Behaviors
There are several behaviors that can potentially heighten health concerns and make symptoms worse. These behaviors include:
1) Avoiding usual activities and treating yourself like a sick person.
2) Excessively examining yourself and seeking medical tests.
3) Excessively seeking reassurance from a range of people and frequent medical appointments.
4) Excessively searching medical conditions in the media, or using the Internet World Wide Web.
These behaviors become counterproductive because they are undertaken to reduce anxiety, but eventually they increase anxiety and symptom perception.
1) Avoiding usual activities
Avoidance increases anxiety because the person incorrectly assumes that a particular activity caused his symptom, then avoids it to protect himself. However, since the activity did not cause the symptom, limiting the activity only leads to more problems.
Limiting activities like a sick person means you never get a chance to prove your original idea wrong, and move on with life.
2) Excessively examining yourself and seeking tests
Focusing attention on a sensation intensifies the sensation, and we exacerbate the irritation by the action we think will relieve it. For instance, feeling a lymph node you think is swollen over and over will bruise the tissue and make the node more tender. Anxiety increases along with the suspicion that there is a tumor, and the cycle continues.
Many people believe the only way to rule out a problem is with a test, and that positive test results are reliable, but negative test results are suspicious. This leads to requesting more tests, risking adverse reactions to the tests, and not feeling reassured anyway. Anxiety about having a serious illness lingers.
3) Excessively seeking frequent reassurance
People seek reassurance in many direct and indirect ways. They often notice that they feel reassured for awhile, but then the doubts about how they presented their story set in and anxiety replaces reassurance. They're back where they started from, but even more worried and convinced they are really sick. You can get whatever information you are looking for to confirm a belief if you look hard enough!
4) Researching medical symptoms
_ While we need to be informed health care consumers, there is a limit to the type and amount of
information that is beneficial. Remember "medical student syndrome," where medical students
become very anxious about new diseases they are studying, and begin to attribute long-standing
normal sensations to this new disease. Soon they're in the student health clinic, convinced they have a horrible illness. Instead of looking up symptoms and gathering an array of unlikely causes, start by looking at common sense factors that you can control. If the symptom persists, report it to your doctor.
Beware of being swept up in newspaper and television reports on specific illnesses. Having only seconds to report on the condition can yield a sensationalistic tone and make the condition sound more common and threatening than it actually is.
Managing Medical Symptoms
Pleasant Events Suggestions
(Adapted from Skills Training Manual by Marsha Linehan)
Session Five Patient Handout
1. Soak in the bathtub
2. Collect things
3. Plan a vacation
4. Take a day off
5. Arrange flowers
6. Practice religion
7. Go to a movie in the middle of the week
8. Get together with friends
9. Doodle, paint, needlepoint
10. Think "I'm an OK person."
11. Jog, walk, hike
12. Go camping, to the beach, fishing
13. Listen to music
14. Lie in the sun
15. Play with animals
16. Play a musical instrument
17. Go out for coffee, lunch
18. Join a club, or group
19. Buy clothes
20. Hobbies
21. Make a gift for someone
22. Meet new people
23. Go to the beauty salon
24. Remember beautiful scenery
25. Go to a play, concert, movie
26. Spend money on yourself
27. Complete a task
28. Think about pleasant events
29. Repair something
30. Play with children
31. Remember kind words
32. Take care of plants, gardening
33. Swim
34. Help out in the community
35. Think "I am a person who can cope!"
COMMON DISTORTIONS OF THINKING
1. JUMPING TO CONCLUSIONS e.g., The Dr. prescribed an antipsychotic medication. I must be psychotic.
2. GENERALIATION e.g. A. Everybody is better off than me. B. I'm different from everybody else. C. My last boyfriend/girlfriend lied to me. You can't trust men/women)
3. FORTUNE TELLING: What if,? Etc. Predicting the future, e.g. I am going to be just like my mother's aunt Sally. What if this medication makes me worse?
4. THINKING IN EXTREMES: e.g. I am right and he is wrong. Saying: " I hate you!", instead of saying: "Sometimes I dislike the way you behave.
CHALLENGE YOUR THOUGHTS
1 .First Identify Them (Observe them as uncritically as possible
2.Do Not Identify With Them (You did not create them).
Do your thoughts represent an accurate picture of reality as you know it, Qf is it a ••distortion ?
Come up with a more realistic thouaht
Managing Medical Symptoms
Session Six Summary
Patient Handout
Moods
Certain emotions and moods affect physical symptoms for two main reasons:
1) Anxiety, depression, and stress can intensify bodily symptoms because emotional states cause changes in the major systems of the body - the nervous, cardiovascular, and endocrine systems. These sensations can be easily misinterpreted to mean that new medical problems have arisen.
2) Mood can also change how you evaluate bodily sensations, and how you think about health and illness.
Anxiety
Anxiety is a state of being on the lookout for both internal and external threats. Anxious people
expect harm, and pay selective attention to observations they perceive as dangerous and
threatening.
The physical effects of anxiety include increased heart rate, muscle tension, sweating, flushing, dry mouth, stomach churning, lower pain threshold and tolerance. Anxious people are more tuned in to bodily sensations, and when these anxiety-induced changes are added, they think new and ominous conditions are developing.
Depression
Depressed people may feel defective, punished, or damaged in some way. They dwell on
negative memories, and focus on suffering and death. Depressed people are preoccupied with
internal processes, and mistake symptoms of depression for symptoms of dire illness.
Depression can cause physical changes such as low energy, trouble sleeping, appetite changes,
and constipation.
Stress
Stress also causes dramatic changes in the body, which can become alarming if you're not aware that stress is the culprit. Refer back to the handout from Session Three on stress signals. It is important to take time to identify and modify the source of stress and how you are responding.
***How to make this information work for you***
Stop every so often and ask yourself how am I feeling? How has my mood been lately? What's been on my mind? When we don't make the time to pay attention to how we're feeling, the mind and body work together to get our attention! There are some strategies you can use to feel better when anxious or mildly depressed.
Reducing Anxiety
Practice relaxation with your audiotape or relaxing music; do a brief relaxation; get some
exercise or do some stretches; take direct action to solve something that you are worried about;
use distraction techniques to get away from worries and sensations; use the thought stopping
technique; keep your thoughts in the present moment; engage in a pleasurable activity; postpone
worrying until an appointed time later in the day.
Lifting Depression
in a
Mild depression often lightens when you take action or control of a situation; get up, showered and dressed even if you don't feel like it; get exercise or go for a walk; plan a structured, enjoyable activity to look forward to every day; challenge negative thoughts; have a structured, enjoyable activity to look forward to every day; reach out and talk to a friend about problems; get out of the house and be around people; watch a comedy movie; get involved with others in common project; do something that makes you feel good about yourself.
MANAGING MEDICAL SYMPTOMS READING LIST
Stress Management and Relaxation
Minding the Body, Mending the Mind. Joan Borysenko. Bantam, 1988.
The Wellness Book. Herbert Benson and Eileen Stuart. Simon & Schuster/Fireside, 1992
The Woman's Comfort Book. Jennifer Louden. Harper SanFrancisco, 1992.
The Stress Solution-An Action Plan to Manage the Stress in Your Life. Lyle Miller and Alma
Dell Smith. Pocket Book, 1993.
Wellness at Work-Building Resilience to Job Stress. Valerie O'Hara. New Harbinger
Publications, 1995.
Wellness and Symptom Management
Stop Suffering Now. Arthur J. Barsky and Emily C. Deans. HarperCollins, 2005.
Managing Pain Before It Manages You. Margaret Caudill. Guilford Press, 1995.
Healing Mind, Healthy Woman. Alice Domar and Henry Dreher. Henry Holt & Co, 1996.
Living a Healthy Life with a Chronic Condition. Kate Lorig, Holstead Holman. Bull Publishing
Co, 1994.
The Healthy Mind Healthy Body Handbook. David Sobel and Robert Ornstein.
HarperCollins, 1996.
It's Not All in Your Head. Gordon JG Asmundson and Steven Taylor. Guilford Press, 2005
Stop worrying About your Health! George Zgourides. Oakland, CA: New Harbinger
Publications, 2002
Back Sense. Ronald D. Siegel, Michael H. Urdang, Douglas R. Johnson. Broadway Books,
2001.
The Feeling Good Handbook. David Burns. Penguin, 1989.
Mind Over Mood. Dennis Greenberger and Christine Padesky. Guilford Press, 1995.
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sleeplessMom
- Posts: 81
- Joined: Tue Aug 22, 2006 2:16 pm
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Charlie Brown
- Posts: 442
- Joined: Mon Sep 04, 2006 2:56 pm
I am the queen of worry. I had chills last month and then night sweats two days before my period. This month I have had chills a few times many hot flashes and mild night sweats. I go online and assume I have a tumor, cancer or menopause at 35. I have been going crazy! I am on antibiotics for a breast infection, but that doesn't explain last months chills. The hot flashes are new too and mild nightsweats.
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Mello Nello
- Posts: 299
- Joined: Thu Feb 17, 2005 2:00 am