RESEARCH FINDINGS USING GUIDED IMAGERY FOR ANXIETY  July, 2006

What are Anxiety Disorders?

Anxiety disorders is an umbrella term used to describe a wide diversity of psychological conditions. The two major anxiety disorders are Generalized Anxiety Disorders (GAD) and Panic Disorders. Others include Post-Traumatic Stress Disorders (PTSD), phobias, separation anxiety, performance anxiety, and Obsessive-Compulsive Disorders (OCD).

All of these conditions are marked by feelings of apprehension, tension, or uneasiness which can range from mild to incapacitating. Physical symptoms can include stress, palpitations, and sweating. The severity of these symptoms can vary. No single cause seems to be responsible for anxiety disorders. Both psychological and physical causes are usually involved. Genetics can also play a role.

Medical Treatment of Anxiety

Treatment depends on the precise anxiety disorder. Serotonin-reuptake inhibitors (SSRIs) are the most frequent initial medications prescribed. Other medications include benzodiazepines, trycyclics (if depression is also involved), MAO inhibitors (for OCD), beta-blockers (for phobias), and clonidine (for PTSD).

Non-pharmacologic treatment including imagery

The most effective approach is cognitive-behavior therapy (CBT). It is usually combined with medication.

Mind-body approaches have proven effective in cases of situational anxiety, such as test-taking (Wachelka and Katz, 1999), fear of flying (Aitken and Benson, 1984), undergoing surgery (Saadat, Drummond-Lewis, et al, 2006; Simmons, Chabal, et al, 2004; Tusek, Church, et al, 1997; Tusek, Cwynar, 1999); and in dealing with illnesses or conditions such as heart trouble (van Dixhoorn & White, 2005; Vila, Benedicto, et al, 2005), cancer (Deng & Cassileth, 2005; Hidderley & Holt, 2004), infertility (Chan, Ng, et al, 2006), pregnancy (Bastani, Hidarnia, et al, 2005; Rees, 1995; Teixeira, Martin, et al, 2005), and childbirth (Almeida, de Sousa, et al, 2005).

Many medical studies confirm the effectiveness of CBT for anxiety disorders (Borkoved & Ruscio, 2001; Butler, Fennell, et al, 1991; Lenz & Demal, 2000; Silverman, Kurtines, et al, 1999; Toren, Wolmer, et al, 2000). CBT can sometimes be so effective that it can replace medication in treating the symptoms of OCD and PTSD (Basco, Glickman, et al, 2000).

Studies also confirm the effectiveness of the mind-body techniques of guided imagery (Rees, 1995; Tusek, Cwynar & Cosgrove, 1999), relaxation (Aitken & Benson, 1984; Eppley, Abrams & Shear, 1989; Mathew, Ho, et al, 1981; Pender, 1985; Wachelka & Katz, 1999; Weber, 1996), hypnosis (Ashton, Whitworth, et al, 1997; Bryant, Moulds, et al, 2005; Benson, Frankel, et al, 1978; Davidson, Farnbach & Richardson, 1978; Stetter, Walter, et al, 1994), meditation (Finucane & Mercer, 2006; Kabat-Zinn, Massion, et al, 1992; Reibel, Greeson, et al, 2001), autogenic training (Hidderley and Holt, 2004; Jorm, Christensen, et al, 2004) and biofeedback (Clark & Hirschman, 1990; Rice, Blanchard & Purcell, 1993).

CBT and/or mind-body therapies have been effective in all types of anxiety disorders and across all age ranges (Barrett, 1998; Barrett, Duffy, et al, 2001; Barrowclough, King, et al, 2001; Craske MG, Golinelli, et al, 2005; Kendall & Southam-Gerow, 1996; Klinger, Bouchard, et al., 2005; Otto & Smits, 2004; Rayburn & Otto, 2003; Stanley, Beck, et al, 2003), and patients reported feeling more in control of their lives (Pender, 1985; Weinman, Semuch, et al, 1983), even when delivery is computer-assisted (Kenardy, Dow, et al, 2003).

These positive benefits have been sustained in follow-ups as long as six years (Barrett; Barrowclough, King et al; Kenardy, Robinson, et al, 2005; Kendall and Southam-Gerrow). In a study of over 1000 patients, behavioral medicine (relaxation response, cognitive restructuring, exercise, and nutrition) was able to significantly reduce anxiety as well as its medical symptoms (Nakao, Fricchione, et al, 2001). A biofeedback study of 45 people with GAD showed “significant reduction” in one measure of anxiety and its physical and psychological symptoms (Rice, Blanchard and Purcell, 1993).

Herbert Benson, a researcher famous for his studies on relaxation, and his colleagues, reported the effectiveness of meditation-based relaxation and self-hypnosis in the treatment of anxiety (Benson, Frankel, et al, 1978). A study of people with OCD showed that mental imagery could be used successfully to “freeze” the anxiety trigger in order to reduce fear and avoidance behavior in subjects (Riskind, Wheeler & Picerno, 1997). Self-help audiotapes and/or multimedia self-help programs have also been effective (Davidson, Farnbach & Richardson, 1978; Finch, Lambert & Brown, 2000).

Reviews of the literature confirm that all forms of CBT are “likely to provide some benefit for adults” (Rodebaugh, Holoway, and Heimberg, 2004), with relaxation techniques having the strongest evidence for generalized anxiety, panic disorders, dental phobia, and test anxiety, and autogenic training and meditation having some evidence to support their effectiness for generalized anxiety (Jorm, Christensen, et al, 2004).

Studies confirm physiological changes occur after using mind body techniques. After using relaxation training, one small study showed that subjects’ anxiety and platelet MAO levels were significantly lower (Mathew, Ho, et al, 1981), while in another study, subjects’ salivary cortisol levels were greatly reduced and salivary immunoglobulin A (sigA) levels significantly increased (Pawlow and Jones, 2005). Another 2005 study confirmed both physiological and psychological changes (Tafet, Feder, et al, 2005).

Conclusion

A program that includes imagery, relaxation, and behavioral changes can be a low cost, effective way for patients to actively participate in managing the symptoms of anxiety disorders.

REFERENCES

Aitken JR, Benson JW. The use of relaxation/desensitization in treating anxiety associated with flying. Aviat Space Environ Med. 1984 Mar;55(3) :196-9.
Almeida NA, de Sousa JT, Bachion MM, Silveira Nde A. [The use of respiration and relaxation techniques for pain and anxiety relief in the parturition process] [Article in Portuguese] Ret Lat Am Enfermagem. 2005 Jan-Feb;13(1):52-8. Epub 2005 Mar 3.
Ashton C Jr, Whitworth GC, Seldomridge JA, Shapiro PA, Weinberg AD, Michler RE, Smith CR, Rose EA, Fisher S, Oz MC. Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial. J Cardiovasc Surg (Torino). 1997 Feb;38(1):69-75.
Barrett PM. Evaluation of cognitive-behavioral group treatments for childhood anxiety disorder. J Clin Child Psychol. 1998 Dec;27(4) :459-68.
Barrett PM, Duffy AL, Dadds MR, Rapee RM. Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up. Journal of Consulting and Clinical Psychology. 2001 Feb; 69 (1): pp. 135-41.
Barrowclough C, King P, Colville J, Russell E, Burns A, Tarrier N. A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. J Concult Clin Psychol. 2001 Oct;69(5):756-62.
Basco MR, Glickman M, Weatherford P, Ryser N. Cognitive-behavioral therapy for anxiety disorders: why and how it works. Bull Menninger Clin. 2000 Summer;64(3 Suppl A) :A52-70.
Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. J Midwifery Womens Health. 2005 Jul-Aug;50(4):e36-40.
Benson H, Frankel FH, Apfel R, Daniels MD, Schniewind HE, Nemiah JC, Sifneos PE, Crassweller KD, Greenwood MM, Kotch JB, Arns PA, Rosner B. Treatment of anxiety: a comparison of the usefulness of self-hypnosis and a meditational relaxation technique. An overview. Psychother Psychosom. 1978 30(3-4):229-42.
Borkoved TD, Ruscio AM. Psychotherapy for generalized anxiety disorder. J Clin Psychiatry. 2001 62 Suppl 11:37-42; discussion 43-5.
Bryant RA, Moulds ML, Guthrie RM, Nixon RD. The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. J Consult Clin Psychol. 2005 Apr;73(2):334-40.
Butler G, Fennell M, Robson P, Gelder M. Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. J Consult Clin Psycol. 1991 Feb;59(1) :167-75.
Centers for Disease Control and Prevention. National Center for Health Statistics, Vital and Health Statistics Series 13, No. 143. 1997.
Chan CH, Ng EH, Cha CL, Ho, Chan TH. Effectiveness of psychosocial group intervention for reducing anxiety in women undergoing in vitro fertilization: a randomized controlled study. Fertil Steril. 2006 Feb;85(2):339-46.
Clark ME, Hirschman R. Effects of paced respiration on anxiety reduction in a clinical population. Biofeedback Self Regul. 1990 Sep;15(3):273-84.
Craske MG, Golinelli D, Stein MB, Roy-Byrne P, Bystritsky A, Sherbourne C. Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting? Psychological Medicine. 2005 Nov;35 (11): pp. 1645-54.
Davidson GP, Farnbach RW, Richardson BA. Self-hypnosis training in anxiety reduction. Aust Fam Physician. 1978 Jul;7(7):905-10.
Deng G, Cassileth BR. Integrative oncology: complementary therapies for pain, anxiety, and mood disturbances. CA Cancer J Clin. 2005 Mar-Apr;55(2):109-16.
Eppley KR, Abrams AI, Shear J. Differential effects of relaxation techniques on trait anxiety: a meta-analysis. J Clin Psychol. 1989 Nov;45(6) :957-74.
Facts About Anxiety Disorders. National Institute of Mental Health. 2001, rev. 2006. http://www.nimh.nih.gov/publicat/adfacts.cfm
Accessed, July, 2006.
Finch AE, Lambert MJ Brown GJ. Attacking anxiety: a naturalistic study of a multimedia self-help program. J Clin Psychol. 2000 Jan;56(1) :11-21.
Finucane A, Mercer SW. An exploratory mixed methods study of the acceptability and effectiveness of Mindfulness-Based Cognitive Therapy for patients with active depression and anxiety in primary care. BMC Psychiatry. 2006 Apr 7;6:14.
Harman JS, Rollman BL, Hanusa BH, Lenze EJ, Shear MK. Physician Office Visits of Adults for Anxiety Disorders in the United States, 1985–1998. J of General Internal Medicine. Vol 17 Issue 3 March 2002. 165.
Hidderley M, Holt M. A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. Eur J Oncol Nurs. 2004 Mar;8(1):61-5.
Jorm AF, Christensen H. Griffiths KM, Parslow RA, Rodgers B, Blewitt KA. Effectiveness of complementary and self-help treatments for anxiety disorders. Med J Aust. 2004 Oct 4;181(7 Suppl):S29-46.
Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG, Fletcher KE, Pbert L, Lenderking WR, Santorelli SF. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry. 1992 Jul;149(7) :936-43.
Kenardy JA, Dow MG, Johnston DW, Newman MG, Thomson A, Taylor CB.A comparison of delivery methods of cognitive-behavioral therapy for panic disorder: an international multicenter trial. Journal of Consulting Clinical Psycholy. 2003 Dec;71 (6): pp. 1068-75.
Kenardy J, Robinson S, Dob R. Cognitive behaviour therapy for panic disorder: long-term follow-up. Cognitive Behavioural Therapy. 2005; 34 (2): pages 75-8.
Kendall PC, Southam-Gerow MA. Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth. J Consult Clin Psychol. 1996 Aug;64(4):724-30.
Klinger E, Bouchard S, Legeron P, Roy S, Lauer F, Chemin I, Nugues P.Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study. Cyberpsychol Behav. 2005 Feb;8(1):76-88.
Lenz G, Demal U. Quality of life in depression and anxiety disorders: an exploratory follow-up study after intensive inpatient cognitive behaviour therapy. Psychopathology. 2000 Nov-Dec;33(6):297-302.
Mathew RJ, Ho BT, Kralik P, Weinman M, Claghorn JL. Anxiety and platelet MAO levels after relaxation training. Am J Psychiatry. 1981 Mar;138(3):371-3.
Nakao M, Fricchione G, Myers P, Zuttermeister PC, Baim M, Mandle CL, Medich C, Wells-Federman CL, Martin Arcari P, Ennis M, Barsky AJ, Benson H. Anxiety is a good indicator for somatic symptom reduction through behavioral medicine intervention in a mind/body medicine clinic. Psychother Psychosom. 2001 Jan-Feb;70(1):50-7.
Otto MW, Smits JA, Reese HE. Cognitive-behavioral therapy for the treatment of anxiety disorders. Journal of Clinical Psychiatry. 2004;65 Suppl 5:34-41.
Pawlow LA, Jones GE. The impact of abbreviated progressive muscle relaxation on salivary cortisol and salivary immunoglobulin A (sigA). Appl Psychophsiol Biofeedback. 2005 Dec;30(4):375-87.
Pender NJ Effects of progressive muscle relaxation training on anxiety and health locus of control among hypertensive adults. Res Nurs Health.1985 Mar;8(1):67-72.
Rayburn NR, Otto MW. Cognitive-behavioral therapy for panic disorder: a review of treatment elements, strategies, and outcomes. CNS Spectrum. 2003 May;8 (5):pp. 356-62.
Rees BL. Effect of relaxation with guided imagery on anxiety, depression, and self-esteem in primiparas. J Holist Nurs. 1995 Sep;13(3):255-67.
Reibel DK, Greeson JM, Brainard GC, Rosenzweig J. Mindfulness-based stress reduction and health-related qualify of life in a heterogeneous patient population. Gen Hosp Psychiatry, 2001 Jul-Aug;23(4):183-92.
Rice KM, Blanchard EB, Purcell M. Biofeedback treatments of generalized anxiety disorder: preliminary results. Biofeedback Self Regul. 1993 Jun;18(2):93-105.
Riskind JH, Wheeler DJ, Picerno MR. Using mental imagery with subclinical OCD to ‘freeze’ contamination in its place: evidence for looming vulnerability theory. Behav Res Ther. 1997 Aug;35(8) :767-68.
Rodebaugh TL, Holaway RM, Heimberg RG. The treatment of social anxiety disorder. Clin Psychol Rev. 2004 Nov;24(7):883-908.
Saadat H, Drummong-Lewis J, Maranets, I, Kaplan D, Saadat A, Wang SM, Kain ZN. Hypnosis reduces preoperative anxiety in adult patients. Anesth Analg. 2006 May;102(5):1394-6.
Silverman WK, Kurtines WM, Ginsburg GS, Weems CF, Lumpkin PW, Carmichael DH. Treating anxiety disorders in children with group cognitive-behavioral therapy: a randomized clinical trial. J Consult Clin Psychol. 1999 Dec;67(6):995-1003.
Simmons D. Chabal C, Griffith J, Rausch M, Steele B. A clinical trial of distraction techniques for pain and anxiety during cataract surgery. Insight. 2004 Oct-Dec;29(4):13-6.
Stanley MA, Beck JG, Novy DM, Averill PM, Swann AC, Diefenbach GJ, Hopko DR. Cognitive-behavioral treatment of late-life generalized anxiety disorder. Journal of Consulting & Clinical Psychology. 2003 Apr; 71 (2): pp. 309-19.
Stetter F, Walter G, Zimmermann A, Zahres S, Straube ER. Ambulatory short-term therapy of anxiety patients with autogenic training and hypnosis. Results of treatment and 3 month follow-up. Psychother Psychosom Med Psychol.1994 Jul;44(7):226-34.
Tafet GE, Feder DJ, Abulafia DP, Roffman SS. Regulation of hypothalamic-pituitary-adrenal activity in response to cognitive therapy in patients with generalized anxiety disorder. Cognitive, affective & behavioral neuroscience. 2005 Mar; 5 (1): pages 37-40.
Teixeira J, Martin D, Prendiville O, Glover. The effects of acute relaxation on indices of anxiety during pregnancy. J Psychosom Obstet Gynaecol. 2005 Dec;26(4):271-6.
Toren P, Wolmer L, Rosenthal B, Eldar S, Koren S, Lask M, Weizman R, Laor N. Case series: brief parent-child group therapy for childhood anxiety disorders using a manual-based cognitive-behavioral technique. J Am Acad Child Adolesc Psychiatry. 2000 Oct;39(10) :1309-12.
Tusek DL, Cwynar R, Cosgrove DM. Effect of guided imagery on length of stay, pain and anxiety in cardiac surgery patients. J Cardiovasc Manag. 1999 Mar-Apr;10(2) :22-8.
Tusek DL, Church JM, Strong SA, Grass JA, Fazio VW. Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery. Dis Colon Rectum. 1997 Feb;40(2):172-8.
Van Dixhoorn J, White A. Relaxation therapy for rehabilitation and prevention in ischaemic heart disease: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil. 2005 Jun;12(3):193-202.
Vila R, Benedicto M, Pujadas C, Gomez M, Franzi A, Rodriguez L, Juncosa S. [Usefulness of relaxation techniques for patients with ischaemic cardiopathy: intervention in a health district] [Article in Spanish] Aten Primaria. 2005 Jun 30;36(2):78-84.
Wachelka D. Katz R. Reducing test anxiety and improving academic self-esteem in high school and college students with learning disabilities. J Behav Ther Exp Psychiatry. 1999 Sep;30(3):191-8.
Weber S. The effects of relaxation exercises on anxiety levels in psychiatric inpatients. J Holist Nurs. 1996 Sep;14(3):196-205.
Weinman ML, Semuch KM, Gaebe G, Mathew RJ. The effect of stressful live events on EMG biofeedback and relaxation training in the treatment of anxiety. Biofeedback Self Regul. 1983 Jun;8(2):191-20.

Breath Therapy can help with any problems you have with breathing (for example Asthma and Respiratory disease) but it can also help you tackle problems such as heart disease, high blood pressure, stress, anxiety and panic attacks. It can also help Divers learn how to breath correctly, stay relaxed under water and reduce air consumption. All in all, it is a therapy that can have a very profound effect on your health and well-being.

Breathing, just like our other essential bodily functions, is involuntary, it just happens approximately 25,000 times a day without us having to think about it. This is because our bodies have been programmed from birth to perform these functions automatically. Breathing however is unique as it can over time, be modified by the average person. This could mean that over time you have learnt incorrect breathing patterns, which in turn are having a negative effect on your health. The good news is that as it's a learned behaviour it can be changed with the help of a qualified Breath Therapist or your Doctor. This ability forms the basis of breathing techniques that have been part of the Yogic traditions for thousands of years.

Lao Tzu said in 500B.C. “The perfect man breathes as if he is not breathing” its also interesting to note that if you look at breathing rates, the longest living mammals elephants and whales, breath on average 2 - 6 times per minute, dogs and rabbits breath approximately 30 - 40 times per minute and humans between 12 - 14. If you find you are breathing more than this, its a good indication that your health requires attention. 

For anyone with breathing concerns, a combination of traditional and new mind-body techniques have the power to make real changes to your health and wellness, I have included details on some of the more common issues below, however please contact me to arrange your FREE initial consultation to discuss your own individual circumstances and find out if this type of therapy can help you.

There is a saying that goes "When the breath is steady so is the Mind" The way we breathe has far reaching effects on our well-being, infact the oxygen that we inhale is the major source of nutrients for the body, so breathing more effectively can improve your entire health. Through breathing exercises you will increase your lung capacity, learn how smooth, steady breathing helps reduce stress and activates your relaxation response, increases circulation, boosts your metabolic rate and gives you more energy - the list of benefits goes on and on!

During your initial FREE consultation we will discuss your medical history, any concerns you have and your goals. Sessions would include breathing and body awareness exercises, learning how to breathe to correct any problems and how to turn on your relaxation response (for more information please see the section on stress)

 "One of the most important tools you can incorporate into your daily life to effect not only the longevity of your life, but the quality of your life, is a deeper, slower breathing practice. The exercises in Healing Rhythms do just that."

Dr. Andrew Weil
Buy Healing Rhythms

Asthma is classified as a chronic lung disease that cannot be cured, but it can be controlled, this is where the Mindful Clinic can help you. 

During an attack generally breathing becomes difficult, shallow and generally only in the upper part of the lungs. The lungs also tighten up and the air sacs do not expand leading to fear that they will not be able to continue to breath. Typically people with Asthma have problems with exhalation, however every person is different and the signs and symptoms can be different each time and can change over time and depend on the situation. Also it is important to be able to identify your particular triggers. Breath Therapy can help you find out how you breathe and help you make changes to a healthier breathing pattern, these techniques will also enable you to identify an attack at an early stage and take action. You might not be able to stop an attack, but you will be able to reduce its severity.

It has also been found that a high percentage of asthma sufferers regularly or always breathe through their mouths, this allows over breathing (hyperventilation) to occur and the symptoms of asthma can follow.  Sufferers however very often complain that their nose is blocked forcing them to breath through their mouths, to help you, we have included some tips on how to clear your nose in this section. Give them a try as it really is one of the most important changes you can make to managing your condition. In some cases to help shift to nose breathing at night, we would recommend taping your lips vertically with paper tape (put lip salve on first)  – rather radical but whilst it allows breathing through the sides of the mouth if necessary, it can help correct the problem.

By consciously practicing the techniques taught during a Breath Therapay session you will be able to correct any over-breathing habits, bringing breathing volumes to healthy levels and bringing awareness of breathing into daily life. It must be stressed that Breath Therapy for Asthma will not reverse the disease, but it will improve your quality of life and sense of well-being. It should be seen as a complimentary technique to your existing medical treatment and we do not recommend that you stop your medication.

Note: - Over-breathing means that the person is breathing in more air than the body needs. The standard volume of normal breathing for a healthy adult is three to six litres of air per minute. Scientific research conducted by Professor Buteyko over three decades, along with scientific trials at the Mater Hospital in Brisbane in 1995 demonstrated that people with asthma breathe a volume of ten to twenty litres per minute between attacks, and over twenty litres during an attack

Nose Breathing

One way you can really improve your breathing, is to breathe only through your nose. This is because the nose has been designed specifically to clean and prepare the air we breathe, allowing only air of the right moisture and temperature level, free from dust, pollen and other small particles to enter into our delicate lungs. If you think of the air that you breathe as a type of fuel for your body, then I am sure you will agree that you want to deliver only the best possible air quality to ensure you body runs effectively. If on the other hand you breathe through your mouth (as many Asthmatics do) then you are losing out on all the benefits nose breathing can give you.

It is possible to change to nose breathing as this is the way nature intended us to breathe, its just a matter of changing an learned behaviour into the more healthy alternative. Blocked noses can be one of the challenges, try this easy exercise to see if it helps, there are more tips at the bottom of the page. 

Remember to breathe normally through out this exercise, and ONLY through your nose. Please read the instructions a couple of times before you begin.

1.      Starting movements –

Ø      Move your head backwards and forwards very slowly. Remember not to let your head fall back too far rather just look up towards the ceiling. 

Ø      Check that your shoulders are not moving and that your shoulder blades are sliding down your back towards your back pockets.

Ø      Now close your eyes and move slowly feeling the stretch as you breath in and take the chin towards your chest, and breathe out as you look up to the ceiling, its really nice to have a neck so dont let your head fall to far backwards

Ø      Concentrate on how heavy your head feels as it gently drops forward and enjoy the stretch

Ø      Repeat 6 times

2.      Now concentrate on your breathing, breath normally but slowly –

Ø      Close you eyes again and feel the cool air coming into your nostrils as you breathe in and lower your head and how warm the air is as it flows out as you look towards the ceiling

Ø      Repeat 6 times

3.      After a normal breath out, hold your nose –

Ø      Nod your head backwards and forwards three times, remember not to strain your neck and watch your shoulders do not creep up to your ears!

Ø      Let go of your nose and breathe in and out slowly

Ø      Repeat 3 times

4.      After a normal breath out, once again hold your nose –

Ø      Blow gently but don’t let any air escape, be careful not to strain

Ø      This is the same feeling as clearing your ears on the plane or when diving to the bottom of the swimming pool, some people find it easier to wiggle their jaws

Ø      Repeat 6 times

Practise this nose clearing exercise twice a day, if you have a badly blocked nose you can repeat up to 6 times daily.

TIPS

Ø      When you are trying to breathe through your nose, don’t strain to take the air into your nostrils, instead focus on opening your throat and forget about your nostrils. The trick to this is to imagine that you are actually breathing in through a hole in your throat, give it a try it really works!

Ø      Another effective method is to put your opposite hand up under the armpit on the blocked side and breath gently.

Ø      Using a mild saline solution to wash out your sinuses is also a great habit to develop. Net Pots are specifically designed for this and more information on how to use them is available in this section.

Caution – Please see medical advise before practising these exercises if you have an ear, nose or throat infection.

Chronic Obstructive Pulmonary Disease or COPD for short, is a term used to describe a number of breathing problems where there is damage to the breathing tubes and air sacs within the lung. It is a lung condition that encompasses chronic bronchitis (regular phlegm production) and emphysema (damage to the air sacs in the lung) COPD stands for Chronic Obstructive Pulmonary Disease, the symptoms are similar to Asthma but they are different diseases.

In COPD there is permanent damage to airways. The narrowed airways become fixed, so symptoms are chronic (persistent) In Asthma there is inflammation in the airways which causes the muscles in the airways to constrict. This again causes the airways to become narrow, but the symptoms come and go, and vary in severity from time to time. People with Asthma quickly learn what triggers an attack, it could be pet hair, dust or cold air for example.

There are approximately 30,000 deaths each year from COPD in the UK (NICE 2004). Smoking is the main cause, however evidence suggests that there would be around 4000 fewer of these deaths if occupational risks (dusts, smoke, fume) were removed. COPD is a major cause of disability and death and it is the 4th leading cause of death throughout the world.

Smoking is the cause of COPD in the vast majority of cases. Statistics tell us that about 3 in 20 one-pack-per-day smokers, and 1 in 4 two-pack-per-day smokers develop COPD if they continue to smoke because the lining of the airways becomes inflamed and damaged by the smoke. Air pollution and polluted work conditions may cause some cases, or make the disease worse. However, people who have never smoked rarely develop COPD.

Breath Therapy for patients with COPD (who hyperinflate their lungs druing attacks of bronchospasms, panic or exercise) includes a technique called Pursed Lip breathing. This technique includes small inhalations and long pursed-lipped exhalation. Once mastered, it helps control exhalation by preventing collapse of your airways, learned at rest, it can be applied during exercise and panic. It is also helpful to learn other breathing exercises that help to strengthen the muscles needed for breathing. Both of these techniques along with deep relaxation can be incorporated as needed into your sessions.

It must be stressed that Breath Therapy for COPD will not reverse the disease, but it will improve your quality of life and sense of well-being. It should be seen as a complimentary technique to your existing medical treatment.

RESEARCH FINDINGS USING GUIDED IMAGERY FOR ASTHMA July, 2006

Prevalence and costs

Asthma is a large, growing, and expensive health problem in all industrialized countries (American Lung Assn.). 

According to the Labor Occupational Safety & Health Administration, 15% of disabling asthma cases are work related. Occupational asthma is the most common type of occupational lung disease in the industrialized nations (Rabatin, 2001).

Workers with asthma are twice as likely to retire early; they have higher rates of absenteeism, and they rate their ability to work and their general health as poorer than non-asthmatic workers (Sauni, Oksa et al, 2001). Baking, electronics, chemical and metal manufacturing, paints and plastics, farming, and house cleaning are the highest risk occupations (Rabatin; Sauni, 2001).

What is asthma?

Asthma is thought to result from genetic sensitivity, environmental exposure to irritants and stress responses that lead to a cycle of “hyper-responsiveness” and inflammation in the bronchi. This inflammation, along with excess mucus production, can close airways and make breathing out difficult. Once established, this cycle is difficult to stop.

Medical treatment of asthma

Standard medical treatment includes daily use of an inhaled steroid medication, as-needed use of a bronchodilator (or “rescue medication”), and avoidance of environmental asthma “triggers.” (Oral medications are sometimes needed as well.) The biggest problem in asthma care is noncompliance, particularly with the steroid inhalers. Seventy percent of patients in some studies (Rand & Wise, 1994) either failed to take prescribed daily inhalers, or never filled the prescriptions (Piecoro, Potoski et al, 2001)

Non-pharmacologic treatment including imagery

According to researchers Bloomberg and Chen (2005) at St. Louis Children's Hospital, "The mind-body paradigm that links psychologic stress to disease is necessary when considering the global evaluation of childhood asthma." The mind-body connection is important in adult asthma, as well.

Behavioral and mind/body approaches are also used to control inflammation and spasm. Guided imagery was able to increase oxygenation in COPD patients (Louie, 2004). In two British studies, hypnosis reduced hyper-responsiveness, and increased forced expiratory volume through one year of follow up in adult patients who were easily hypnotized (Ewer & Stewart, 1986).

In a group of 250 patients who had not been tested for susceptibility, 59% of those receiving hypnotic suggestion were rated as “much better,” compared with 40% of a group who received relaxation training without hypnotic suggestions (Maher-Loughna, Macdonald et al, 1962).

Guided imagery uses deep relaxation and positive suggestion in ways nearly identical to hypnosis. The terms “self-hypnosis” or “auto-hypnosis” are used almost interchangeably with “guided imagery” in the literature (Olness, 1981).

A meta-analysis by Hackman, Stern, and Gershwin showed that, though larger, more randomized studies were needed, hypnosis has shown definite, long-term effectiveness in asthma, and that effectiveness is enhanced by the use of self-hypnosis. In one study, 303 pediatric asthmatics were offered hypnosis; some patient’s symptoms resolved after one session, and there was measurable improvement in 80% of those participating. No patients’ symptoms worsened (Anbar, 2002).

In another study of self-hypnosis with children, the researcher followed participants for a mean of nine months post-hypnosis. Positive results were recorded in 13 patients. Two of the children had no more symptoms and were able to discontinue their medication (Anbar, 2001). Hypnosis, combined with an education program, improved pediatric cooperation and compliance with taking peak flow measurements (Lehrer, Feldman et al, 2002).

In another study, adult asthmatics who listened to imagery tapes were less depressed an anxious, and were able to use less medication (Report, 1997). Asthma education programs that instruct patients about asthma, medications, and avoiding triggers, as this program does, help to reduce asthma morbidity.

According to a 2005 Mayo Clinic review of the hypnosis literature (Stewart, 2005), no fewer than five studies showed positive results for asthma patients using hypnosis; results included a large multicenter trial, with hypnosis patients reporting a "significant decrease" in failed treatments and an even larger number deemed "much improved" (Hypnosis for asthma, 1968).

In another study, 54% of hypnosis patients had "excellent" results, and 21% became asymptomatic and were able to discontinue medication (Collison, 1975).

In the Freeman and Welton 2005 study, the results were contrary to the researchers' hypothesis when it was shown that biologically targeted imagery was more efficacious than critical thinking asthma management.

Biofeedback was also effective in reducing some asthmatics’ dependence on steroid medication (Lehrer, Vaschillo, et al, 2004).

Team or combination approaches in asthma management can be beneficial, as with Stanford University School of Medicine's multicomponent program (Shames, Sharek et al, 2004).

Remarkable improvement occurred in the Anbar-Hummell (2005) multicomponent approach which incorporates hypnosis; 82% of their patients showed either improvement or resolution of their primary symptoms.

Conclusion

A low-cost imagery intervention may reduce asthmatic patients’ anxiety and use of medical services, and improve their pulmonary function.

REFERENCES

Anbar R D. Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatr. 2002 Dec 3;2(1):11
Anbar RD. Self-hypnosis for management of chronic dyspnea in pediatric patients. Pediatrics. 2001 Feb;107(2):E21.
Anbar RD, Hummell KE. Teamwork approach to clinical hypnosis at a pediatric pulmonary center. Am J Clin Hypn. 2005 Jul;48(1):45-9.
Bloomberg GR, Chen E. The relationship of psychologic stress with childhood asthma. Immunol Allergy Clin North Am. 2005 Feb;25(1):83-105.
Centers for Disease Control, National Center for Health Statistics. Asthma. http://www.cdc.gov/nchs/fastats/asthma.htm Accessed June, 2006.
Collison DR. Which asthmatic patients should be treated by hypnotherapy? Med J Aust. 1975;1:776-781.
Ewer TC, Stewart DE. Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomized controlled trial. British Medical Journal.1986 Nov 1; 293 (6555) 1129-32.
Family Guide to Asthma and Allergies. (1997). American Lung Association Asthma Advisory Group with Norman Edelman, MD. Little, Brown: New York.
Freeman LW, Welton D., Effects of imagery, critical thinking, and asthma education on symptoms and mood state in adult asthma patients: a pilot study. J Altern Complement Med. 2005 Feb;11(1):57-68.
Hackman RM, Stern JS, Gershwin ME. Hypnosis and asthma: a critical review. Journal of Asthma. 2000; Feb 37(1): 1–15.
[no authors listed] Hypnosis for asthma—a controlled trial: a report to the Research Committee of the British Tuberculosis Association. Br Med J. 1968;4:71-76.
Kohen DP. Applying hypnosis in a preschool family asthma education program: uses of storytelling, imagery and relaxation. American Journal of Clinical Hypnosis. 1997; 39 (3): 169-81.
Lehrer P, Feldman J, Giardino N, Song H, Schmaling K. Psychological aspects of asthma. Journal of Consulting and Psychology. 2002 70(3):691-711.
Lehrer PM, Vaschillo E, Vaschillo B, Lu SE, Scardella A, Siddique M, Habib RH. Biofeedback treatment for asthma. Chest. 2004 Aug; 126 (2): pages 352-61.
Lewith GT, Watkins AD. Unconventional therapies in asthma: an overview. Allergy.1996 Nov, 51(11):761-9.
Louie SW. The effects of guided imagery relaxation in people with COPD. Occup Ther Int. 2004 11(3):145-59.
Maher-Loughna GP, Macdonald N, Mason AA, Fry L. Controlled trial of hypnosis in the symptomatic treatment of asthma. British Medical Journal. 1962 (2): 371-76.
Morrison JB. Chronic asthma and improvement with relaxation induced by hypnotherapy. J R Soc Med. 1988;81:701-704.
National Center for Health Statistics. http://www.cdc.gov/nchs/fastats/asthma.htm Accessed November, 2005. Accessed June, 2006.
Olness K. Imagery (self-hypnosis) as adjunct therapy in childhood cancer. Am. Journal of Pediatric Hematology/Oncology. 1981 3 (3) 313-320.
Piecoro LT, Potoski M, Talbert JC, Doherty DE. Asthma prevalence, cost, and adherence with expert guidelines on the utilization of healthcare services and costs in a state Medicaid population. Health Services Research. 2001, June; 36(2): 357-71.
Rabatin JT. A guide to the treatment of occupational asthma. Clin Proc (Mayo Clinic). 2001 June 76(6):633-40.
Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Resp Crit Care Med. 1994 149: S69-76.
[no authors listed] Report. Alternative Health practitioner: The Journal of Complementary and Natural Care Fall/Winter, 1997 3 (3).
Sauni R, Oksa P, Vattulainen K, Uitti J, Palmroos P, Roto P. The effects of asthma on the quality of life and employment of construction workers. Occupational Medicine (London), 2001 May 51 (3): 163-7.
Shames RS, Sharek P, Mayer M, Robinson TN, Hoyte EG, Gonzalez-Hensley F, Bergman DA, Umetsu DT. Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma. Ann Allergy Asthma Immunol. 2004 Jun;92(6):611-8.
Stewart JH. Hypnosis in contemporary medicine. Mayo Clin Proc. 2005 Apr;80(4):511-24.
United States Department of Labor Department of Labor Occupational Safety & Health Administration.
www.osha.gov/SLTC/occupationalasthma/index.html Accessed June, 2006.
Wyler-Harper J, Bircher AJ, Langewitz W, Kiss A. Hypnosis and the allergic response. Schweizerische Medizinische Wochenschrift. Supplementum. 1994, 62:67-76.

Mindful Relax and Renew

Modern lives are busy lives, and while we may sleep, we rarely take time to rest. During a Relax and Renew therapy session you will learn h