Psychological News You Can Use - June 2009

We hope you find these articles timely and helpful. Feel free to forward them to friends and family who may also be interested in them.

Unique Opportunity to Hear from Psychological Experts - Marti Evans, PPA Conference Manager

Because of the success last year of the Pennsylvania Psychological Association's first Mind-Body Health Workshops for the Public series, the free one-hour workshops will once again be offered on June 17 and 18, 2009, 9:30 a.m. to 7:30 p.m., at the Hilton Harrisburg.

You are invited to attend workshops presented by leading experts in the field of psychology. All sessions are free, and will address common life problems. The experts will also answer questions from the audience.

PPA wants to help you to make healthier choices in your life, and in the lives of those you love. A complete list and description of all 14 workshops is available at psychologycanhelp.com.

• How to Respond to Bullying
• Achieving Work-Life Balance with Support Systems
• Signs and Symptoms of Eating Disorders in Children
• Identifying and Caring for Returning Veterans' Hidden Psychological Wounds
• Caring for the Family Caregivers of Aging Parents
• Resilience in the Family
• Promoting Closeness with Your Child When You Have No Time
• Fostering Self-Esteem in Your Child
• Qigong for Mind-Body Health

Registration is free at psychologycanhelp.com, or call the PPA office at 717-232-3817 for a complete brochure.

PPA hopes you will plan to attend as many of these workshops as you can!

The Challenge of Coping with Illness and Disability

Struggling with disease, disability, or illness can sometimes leave us overwhelmed. We must grapple with both the practical side of managing our health and our care, as well as the emotional aspect of adjusting to life with an illness or disability. Typically the demands we face are not adequately addressed by following simple medical prescriptions. Even when we have supportive friends and family members, we may feel alienated if they do not have first-hand knowledge of our condition. It is not unusual to feel anxious about complex medical information, treatment decisions, and major life changes that come with illness. The symptoms we experience, as well as the impact of the illness on our relationships and on our daily routines, can sometimes lead us to feel frustrated, depressed, disconnected and out of sync.

Particularly when illness is life-threatening or involves permanent disability or chronic pain, we may enter a process of grieving, as we adjust to ways in which previous priorities and concerns no longer make sense, and our life's meaning and purpose must be continually reconstructed. This may also be true for our loved ones whose lives are also affected.

How Support Groups Work

Support groups allow us to connect with others who are experiencing similar challenges. In hearing their stories, we can begin to identify aspects of our own private struggles that turn out to be universal and shared. They can provide us with a safe and accepting place to discuss our own experiences. We learn that we are not alone.

On a very basic level, support groups give us information about our care that goes beyond the viewpoint we get from medical staff. They can help us access medical and non-medical resources. Sometimes we might never uncover some highly useful and important resources without connecting to a larger community. For example, a friend with cancer discovered through his local cancer support organization that a very exclusive local fitness center offered free membership to people battling cancer. This discovery immensely improved the quality of his life during this trying time. Support groups also give us a place to learn coping mechanisms from others, saving us much trial-and-error as we try to develop mechanisms on our own.

By learning from others' ways of coping, we can come to see that although many aspects of our experience are not in our control, there are things we can do to cope effectively. In this way, we can reduce our feelings of helplessness by focusing on the parts of the experience we can control, rather than anxiously dwelling on the parts we cannot control.

Support groups can offer us hope in darker times. With any major illness or disability, there are often periods of frustration and downright despair that alternate with periods of competency, self-assurance, and serenity. During the frustrating times, we can lose sight of the cyclical nature of the experience and become isolated, anxious, and depressed. There is nothing more helpful than being around others who have experienced that despair and fully understand how we feel and, by their very presence, inspire us to recognize that lighter moments lie ahead.

Support groups can offer us an opportunity to turn our struggles into strengths. Years ago, I ran a support group in a state psychiatric hospital for HIV+ patients. Chronic psychiatric illness and institutionalization, coupled with the HIV, often led group members to feelings of powerlessness and depression. I remember a very simple, elegant moment in which one group member responded to another's concern about medication side effects of nausea by remarking, "it helps me when I take that medicine with milk." It was such a simple observation, but it turned out to really make a difference for the person he was helping. It was also powerful for him to see that the tools he learned in his own care were of benefit not only to him, but also could benefit others. During this exchange, we could feel the group's mood lift and a sense of hope entered the room as the group members began to use their collective resources to better understand and manage their care.

What Makes a Support Group Good:

Good support groups include the following qualities:

• An atmosphere of caring and trust;
• A clear sense of what to expect, with agreement on group rules, including confidentiality;
• A sense of connection and belonging (cohesion) that is reflected in active, ongoing participation among participants;
• A subjective sense that there is a good mix of participants (enough similarity to allow for identification with others, yet enough diversity to learn different viewpoints);
• Good resources, appropriate to the group's purpose (for example, current medical information and referral sources, community resources, and spiritual information);
• A skilled facilitator (regardless of whether that person is a professional or not);
• Accessibility.

How Do I Find a Support Group?

There are support groups for almost any illness and condition that exists. Support groups may serve people who share a specific diagnosis (or related diagnoses, such as many types of cancer), or they may serve significant others, such as caregivers and relatives. They can be found through hospitals and medical providers, national and local organizations that serve a particular illness (such as the American Cancer Society, www.cancer.org, and the Wellness Community, http://www.thewellnesscommunity.org, which both have local chapters), through faith-based and other community organizations, and via media such as the Internet and the telephone book. There are several Web sites that provide lists of support groups (no endorsement implied):

• http://health.msn.com/support-groups
• http://www.dailystrength.org/support-groups
• http://www.cancernews.com/support.html
• (National Organization for Rare Disorders) http://www.rarediseases.org

Once we find a support group, it is important to utilize support in a way that feels uplifting to us. While this article provides some guidelines, ultimately we have to be the best judge of whether a support group is right for us.

Dana Fry is a psychologist in private practice in Swarthmore, PA. You can find out more information about her practice at http://therapists.psychologytoday.com.

 

Animals Improve Human Health - Sybil L. Holloway, Psy.D.

Did you know that spending quality time with animals might be one of the best ways to protect your health? Animals offer companionship and unconditional love, and they can have positive effects on one's physical and psychological health. It has been shown that interactions with animals reduce stress, lower blood pressure, improve heart health, increase mobility and independence, increase self-esteem, and improve mood. Whether the animal is a household pet or part of a medical treatment (animal-assisted therapy, or pet therapy, as it is often called), animal interaction can enhance the quality of your life and may increase your life expectancy.

Household pets

There are lots of animal lovers in the United States. Statistics from the American Veterinary Medical Association show that "there are more than 72 million pet dogs in the U.S. and nearly 82 million pet cats." (www.avma.org/ reference/marketstats/sourcebook.asp). Their U.S. Pet Ownership & Demographics Sourcebook (2007 Edition) also contains information on birds, horses, and specialty and exotic pets.

Pets can offer you the physical benefits of exercise through activities such as walking your dog or riding your horse. They can also provide a calming influence for viewers of a fish aquarium or a napping cat. Common mental health conditions such as anxiety and depression can be partially relieved through animal interaction. Animals are a source of social support and nurturing (e.g., the power of touch) and this can be extremely valuable for the sick, the elderly, the disabled, and the single person. It's hard to resist the validation and love of a welcoming meow, bark, or chirp of an appreciative and playful pet.

Therapeutic use of animals

Another way that animals provide health benefits is through their use in treatment programs. The Delta Society is "a human-services organization dedicated to improving people's health and well-being…through positive interactions with animals." (www.deltasociety.org/Page.aspx?pid=251). Their mission is "…to increase awareness of the positive effects of animals, reduce the barriers that prevent involvement of animals in everyday life and expand the therapeutic and service role of animals in health, service and education." The Delta Society's compiled list of some research findings includes many benefits of human-animal interaction (www.deltasociety.org/Document.Doc?id=380). Several therapeutic programs use the materials and services provided by the Delta Society.

Animal-assisted therapy (AAT) is an alternative therapy that offers many positive contributions to one's health and well-being. American Humane defines animal-assisted therapy as "…a goal-directed intervention in which an animal is incorporated as an integral part of the clinical health-care treatment process. (http://www.americanhumane.org/human-animal-bond/programs/animal-assisted-therapy/)

Casa Palmera, an inpatient treatment center in Del Mar, CA (San Diego county) specializing in the treatment of eating disorders, chemical dependency, trauma, and chronic pain management, lists the following benefits of pet therapy:

• Lowered blood pressure
• Reduced stress and anxiety
• Improved mood
• Non-verbal communication
• Better memory
• Encouragement of nurturing behavior
• Decrease in hospital visits
• Reduced loneliness
• New opportunities to meet people
• Encouragement of physical activity
• Improved self-esteem
• Feeling of importance, love
• Protection from various crimes
• Reduction of small health complications
• Relaxation
• Relief of depression to an extent (www.casapalmera.com/articles/pet-therapy-and-its-benefits/)
  

Some examples:

Eos Therapeutic Riding Center in Bloomsburg, PA, offers "therapeutic horseback riding to children with special needs" (www.eostrc.com).

The Paw Partners pet therapy program offered by the Children's Hospital of Philadelphia "uses the benefits of [animal] interaction to decrease children's stress and anxiety about illness, injury and the healthcare experience by providing visits with certified therapy dogs trained to work in a hospital environment." (www.chop.edu/ consumer/jsp/division/generic.jsp?id=82117).

The Animal Friends Pet Therapy Program based in Pittsburgh "allows patients in nursing homes, adult care facilities, hospitals, children's homes and even homebound individuals to receive the therapeutic effects of human-animal interaction." (www.animal-friends.org/site/petassist.jsp).

Similar animal-assisted therapy programs exist in other states. These links contain listings of such organizations:

www.therapypets.com/animal-assisted-therapy-jackies-list-aaa-aat-practitioners.html

www.dogplay.com/Activities/Therapy/join.html

www.landofpuregold.com/rxb.htm

"Pet Therapy: Healing, Recovery and Love," an article by Pawprints and Purrs, Inc., discusses the healing and helping nature of pets and gives specific examples of people who benefitted from animal assistance. (www.sniksnak.com/ therapy.html).

As you can see, animals can be helpful to many people dealing with a variety of health conditions. When you or your loved ones face a serious physical or psychological condition, consider making pet therapy part of the treatment process.

Dr. Sybil L. Holloway is a Psychological Counselor/Assistant Professor at Bloomsburg University and a freelance writer. For three years, she wrote a monthly "Stressbusters" column for The Morning Call of Allentown, PA. View her articles at www.sybilholloway.com.

You are in pain. You believe the pain should have gone away by now, but it hasn't. Your physician may or may not have run multiple tests. Life goes on and you still hurt. You feel like running away, but you can't escape your own body.

Did you know that pain is one of the most common reasons that a person sees a physician? Persistent pain, whether from disease, various disorders, or accidents, impacts nearly a third of the population each year. There are multiple costs when pain persists, such as emotional and physical distress, as well as the impact on functioning, productivity and being able to do the things you enjoy. It impacts those around you, especially your family. It touches your whole life. Low back pain is the major cause of morbidity and disability in people between the ages of 18 and 44, considered the most active productive work years (Hanson & Gerber, 1990). As one gets past the age of 60 the prevalence of significant pain is twice that in community - dwelling adults as compared to those under the age of 60 (Crook, Rideout and Brown, 1984). Reseachers (Gatchel & Dersh, 2002) have found that those with chronic low back pain have higher levels of depression, anxiety, substance abuse, health concerns, and interpersonal and family issues, and are less likely to return to work.

DEFINING PAIN

What is pain? The International Association for the Study of Pain defines Pain as, "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." It is common for those in pain to exclaim, "I wish someone could step into my body to experience what I am going through." And it can seem that no one can truly understand what you are going through.

Pain is not independent of the person. One must look at the whole person to understand his or her experience of pain. Pain is a complex, multidimensional dynamic experience that incorporates physical, emotional, cognitive, social, and behavioral components. Is there an aspect of your personhood that is not impacted by your experience of pain? One's experience of pain is impacted and modified by various components. Many aspects of your life such as your behavior (activities), thoughts and stress can also impact your pain. The type of relationship that exists between chronic pain and psychological health and dysfunction flows in many directions.

Pain is nature's way of warning us that something is wrong in our body. If the problem is not resolved and pain persists, various bodily systems - such as the immune system and limbic system - are stressed. When pain persists over an extended period of time it is considered chronic in nature. Chronic pain indicates that the body cannot regain homeostasis and is at risk for disability and dysfunction. Although anxiety and uncertainty typically occur in the initial phases of pain, a number of psychosocial problems surface when an individual develops chronic pain.

PREDICTING THE OUTCOME OF PAIN TREATMENT

Measuring pain is difficult. As no two individuals are alike, neither are their pain experiences. Because pain is multidimensional, no single assessment tool can easily capture the richness of the individual and their experience. A person may feel frustrated having to rate his or her pain on a scale of zero to ten, knowing that it cannot truly convey what s/he is experiencing. Imaging studies, such as X-Ray, CAT scans, and MRIs, do not always tell the whole picture. In fact, if a random group of individuals found walking down the street were given such tests, many would show changes in their spine, but have no pain. Yet, many individuals experience pain without showing any positive evidence in imaging studies. Imaging is a tool. Just like pictures from your vacation may show some details, it can't fully capture your experience.

Multiple measures can serve as tools to assist in the assessment, treatment and research of individuals with pain. Psychologists, who have expertise in the measurement of pain, can explore a person's experience of pain in great depth and develop a plan to cope. Many factors can impact a person's progress and outcomes. Interestingly, psychosocial variables - personality characteristics, emotional behaviors, and family support, for example - can better predict pain and disability chronicity than can physical variables (Gatchel & Dersh, 2002).

HOW TO TREAT CHRONIC PAIN

Many regulatory agencies recommend multidisciplinary (National Institutes of Health (NIH, 1996) approaches or adding nonpharmacological approaches for dealing with pain. For hospitalized patients, pain is considered the fifth vital sign by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO). This means that it usually takes a team of professionals to help people with pain. A psychologist is a vital component to that team. For this reason, your physician may recommend a psychologist for treatment of pain, not because s/he thinks something is "wrong with your head" or that "you are crazy" but because psychologists have developed proven techniques for coping with pain. In fact, it is increasingly common and is considered protocol to refer to a psychologist.
In fact, pain is processed by your brain. Interdisciplinary treatment may include relaxation training, cognitive behavioral treatment, biofeedback, activities, attention and diversion training, adjustment and coping issues, family counseling intervention, etc. Adjunctive techniques such as hypnosis may also be introduced. After a patient goes through an individualized program they may wish to join a support group for peer support as well as to reinforce and maintain treatment gains. Some self-help resources are provided at the end of this article.

For persons in chronic pain, the type of coping strategy used affects their levels of pain and depression associated with pain (Covic, Adamson and Hough, 2000). Active strategies are more effective than passive coping strategies when it comes to alleviating pain and depression.

PASSIVE COPING STRATGIES

Out of desperation, people use the passive method of turning to alcohol and recreational drugs or to prescription medications to cope with or escape from pain. Persons with preexisting anxiety, depression, and certain personality characteristics are even more likely to turn to drugs and alcohol. While prescription medications undoubtedly help many people deal with pain, there are a number of people who can become addicted to these medications. The greatest risk for addiction occurs within the first five years following the onset of chronic pain. One problem is that pain patients may develop tolerances to medications and take it upon themselves to adjust their medications, thinking that if one pill no longer helps, maybe two pills will. For this reason, it is important to work with your psychologist and physician in dealing with exacerbations of pain or break through pain. Your medications may also have to be rotated in order to maintain their effectiveness. Another helpful strategy is to develop written behavioral contracts to clarify medication use and decrease confusion about the consequences of not following the prescribed medication regimen. Identifying and addressing issues early, before they get out of control, benefits many users of medications.

ACTIVE COPING STRATEGIES

Cognitive behavioral treatment (CBT) is one of the most successful and well documented (see Gatchel & Peng, 2006) active coping strategies for dealing with chronic pain. Randomized controlled studies consistently document the benefit of CBT for chronic pain. CBT teaches pain patients to think differently about the interpretation of pain and to envision a more positive future in dealing with pain. Patients learn they have more control over pain than previously imagined. Moreover, CBT can assist patients to increase their understanding of their personal value and their importance to family and friends despite having pain. For an effective scientifically based treatment for chronic pain, contact a psychologist in an interdisciplinary treatment program. Then with treatment, initiate changes in your life and begin to more effectively cope with your pain. Discover that you are a person who experiences pain, but is not ruled totally by it, each and every moment. Control your response to pain, don't let pain control you. Then begin to live life more fully, despite your persistent pain.

Resources:

Self-help workbooks

American Chronic Pain Association. (2004). Patient to person: First steps: A workbook for people with chronic pain. Rocklin, CA: American Chronic Pain Association.

Caudill, M. A. (2002). Managing pain before it manages you. (Rev. ed.). New York: Guilford Press.

Swanson, D.W. (Ed.) (1999). Mayo clinic in chronic pain. Rochester, MN: Mayo Clinic.

Turk, D. C., & Winter, F. (2006). The pain survival guide: How to reclaim your life. Washington, DC: American Psychological Association.

Internet Resources

American Chronic Pain Association: http://www.theacpa.org/

American Pain Foundation: NPO site that contains newsletter, downloadable patient resources and discussion boards.
http://www.painfoundation.org

American Psychological Association: Psychology Matters: Health: Pain: http://www.psychologymatters.org/health.html#pain

Nittany Valley Chronic Pain Support group: A pain support group in Centre County, PA. http://painsupport.150m.com/page.html

Oxford Pain Internet Site http://www.medicine.ox.ac.uk/bandolier/booth/painpag/index2.html

Pain Action: An online self-management program for pain patients, featuring individually-customized information, interactive skill-building tools, monthly newsletter and opportunities to share self-management tips. http://www.painaction.com/

Pain.com (Site sponsored by a drug company) http://pain.com/

Pain Connection: A non-profit organization that aims to: improve the quality of life of those suffering from chronic pain; decrease their sense of isolation and alienation; increase control of their condition and treatment; maintain their independence.
http://www.painconnection.org/

Professional

The American Academy of Pain Management: A non-profit organization that educates clinicians about pain and its management through an integrative interdisciplinary approach. http://www.aapainmanage.org/

The International Association for the Study of Pain® (IASP®): A leading professional forum for science, practice, and education in the field of pain. http://www.iasp-pain.org

The American Pain Society: A national chapter of the International Association for the Study of Pain (IASP). http://www.ampainsoc.org/

Hypnosis & Pain Management videos:

http://ewillmarth.com/pain.html

References

Covic, T., Adamson, B., & Hough, M. (2000). The impact of passive coping on rheumatoid arthritis pain. Rheumatology, 39(9), 1027. Retrieved March 10, 2006, from Research Library database. (Document ID: 60968049).

Covic, T., Adamson, B., Spencer, D., & Howe, G. (2003). A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study. Rheumatology, 42(11), 1287. Retrieved March 10, 2006, from Research Library database. (Document ID: 729137671).

Crook, J., Rideout, E., & Brown, G. (1984). The prevalence of pain complaints among a general population. Pain, 18, 299-314.

Gatchel, R. J. (2005). Clinical essentials of pain management. Washington, DC: American Psychological Association.

Gatchel, R. J., & Dersh, J. (2002). Psychological disorders and chronic pain: Are there cause-and-effect relationships? In D.C. Turk & R. J.

Gatchel (Eds.), Psychological approaches to pain management: A practitioner's handbook (2nd ed., pp.30-51). New York: Guilford Press.

Gatchel, R. J., & Peng, Y. B. (2006). Biopsychosocial management of chronic pain. In J. A. Trafton & W.A. Gordon, (Eds.). Best practices in behavioral management of chronic disease. (2006b ed.). Los Altos, CA: Institute of Disease Management.

Hanson, R. W., & Gerber, K. E. (1990). Coping with chronic pain: A guide to patient self-management. New York: Guilford Press.

National Institutes of Health, Technology Assessment Panel. (1996). Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. Journal of the American Medical Association, 276, 313-318.

Trafton, J. A., & Gordon, W.A. (Eds.) (2006). Best practices in behavioral management of chronic disease. (2006b ed.). Los Altos, CA: Institute of Disease Management.

Turk, D., & Gatchel, R. (Eds.). (2002). Psychological approaches to pain management: A practitioner's handbook (2nd ed.). New York: Guilford Press

Wood, P. H. N., & Bradley, E. M. (1980). Back pain in the community. Clinics in Rheumatic Disease, 6, 3-16.

Peter J. O'Donnell, M.A., NCC, NBCDCH, BCIAC, CSP has over twenty four years of clinical experience, is a licensed psychologist, professional counselor, has certifications in counseling, biofeedback, hypnosis, and sports psychology, and is the Director of Psychology, Behavioral Medicine and Neuropsychology at HEALTHSOUTH Nittany Valley Rehabilitation Hospital in Pleasant Gap, Pennsylvania.