# where to go from here...



## misummer nightmare (Feb 14, 2003)

Hi everyone,not sure if this is the right section for me to be posting to but I am very interested in trying get to grips with either a cbt or hypno approach so hopefully someone will have some words of wisdom...i should probably give a bit of a lowdown on my situation as it is a little complicated. I have been severely anorexic for almost 10 years and have had ibs for at least five, very mild at first following refeeding as an inpatient, then signficantly worse after travels to south america. I am currently on the road to recovery with anorexia, out of a critical zone, out of hospital and attending a full time day programme, obviously regular meals and consistent weight gain is a part of that. My syptoms are constant throughout the day, mostly bloating and gas, often bouts of diarrhea that can wake me at 4 am, always feeling constipated despite going a lot, far too much straining and inability to relax sphincter, only able to go without cigarette if I have D (sorry for details). I believe in CBT as it has helped so much with my anorexia but am unsure whether it or hypno would help while I am still battling, my docs say they can't help me until I'm a normal weight but of course its bloody hard getting to a healthy weight when I'm in so much discomfort, it feels like I'm struggling on two fronts. I tried mike's tape a while back but they made me quite edgy...maybe I should give them another go? I don't know if anything will get through to me right now, not that I don't believe they are effective, just I'm worried I'm not responsive. I really believe biofeedback might help. I've tried a million other approaches (nutritional, accupuncture, homeopathy) so i think it's time to start doing the work myself... I feel so stuck, is it Cbt I need or do I just need to grin and bear it till my weight is up? Also how to stop relying on the cigarettes to have a BM - I seem to spend my life on the toilet...how pathetic!Sorry for such a rambling email but any advice would be very much appreciated


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## eric (Jul 8, 1999)

midwinter, I worte out a long reply last night then lost it, with my isp.But I will go over this with you.Right now I think you should try CBT personally.I see you live in London.I am not sure of CBT therapists over there. try emailing the IBS NetWork and see if they can recommend someone for you.Good to hear your working and recoverying from the anorexia.







I will post some more, but let me know what they say to your email? http://www.ibsnetwork.org.uk/ I will also post some more info and resources for you.


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## misummer nightmare (Feb 14, 2003)

Thznks Eric, I also have a feeling cbt might be a better bet for me than hypno for the time being. I'll get in contact with the ibs network and let you know how I get on. Thanks in advance for the other links/info you mentioned


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## Guest (Aug 15, 2004)

Hi Midwinter,Nice to meet you....







Anorexia is an axis II disorder that can also be treated with medications. Surely your present health care givers are aware of this?I have a different type of axis II disorder, I used to have the alternating type of IBS and when I would get the D, it would almost paralyze me with pain and fatigue. I used Mike's recordings as well, and they did provide some good and longlasting help for me in many arenas. I still routinely use the visualizations to help with pain.I've also used a different type of biofeedback...not the type where they hook up the electrodes to your rectum, but the type where they place electrodes in other places to monitor anxiety levels and in the past I achieved some relief using those visualizations.However, since I began taking a medication called Depakote (which helps to treat some axis II disorders), my D has almost completely gone away... in fact I'm now leaning in almost the opposite direction (but that has more to do with my age...I'm menopausal and the lack of estrogen can exacerbate C).Yours is a serious situation. I agree with eric on the CBT, but also think an appropriate medication might help as well. I've put on 20 pounds since I began taking the Depakote and I no longer feel nervous, anxious, fidgety...etc. I also want to eat 24/7....







These days, I find the best medication combination for me is a low dose of both the Depakote (375mg daily) and Celexa (5mg daily). I was off the Celexa for a long time, but the pain of fibromyalgia brought me back to it. I've also noticed that the bloating and gas don't bother me as much since I re-started the Celexa.Hope this helps.I wish you the best. Let us know how you do.Evie


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## misummer nightmare (Feb 14, 2003)

Thanks for your message Essence. I wanted to clarify something though, I think you might be confusing anorexia (loss of appetite) with the psychiatric illness anorexia nervosa, I suffer from the latter although obviously the pain and discomfort of ibs do make it much harder to eat physically as well as emotionally. I've had this problem for a very long time and can tell you that although there are medications which can reduce anxiety and depression which underlie anorexia, they cannot by any means treat it, they can merely aid the process of recovery by taking the edge off the emotional distress. Appetite stimulants are useless in the treatment of eating disorders as they do not have an physical foundation, many anorexics do feel hunger but still deny themselves. However medications certainly have a purpose in anorexia especially when the patient is so chronically depressed s/he cannot respond to treatment. I was on seroxat a few years ago but my doctor doesn't want me on any meds right now as my weight is still extremely low and he is worried about the side effects, I don't feel I need them as I once did though as interested in their role in helping IBS. Thanks again


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## Guest (Aug 16, 2004)

Actually, I was sorta gently leaning towards the behavioral health aspects of axis II disorders, but didn't want to overstep any boundaries.Sometimes antidepressants and anti-anxiety meds (benzos can actually make them worse) aren't the full ticket for these types of disorders which are in the same classification of behavioral health disorder that I have. Mine results from a lack of valproic acid in my brain. Lack of this element can cause an unbelievable variety of symptoms which exist comorbidly and can wreak havoc with a person's life.I actually had mini seizures in my temporal lobes that kept me very thin for a long time. I would consciously not eat even though I knew that I should. Since I've been on Depakote, I eat more and have gained weight.You sound as if you are well educated about your disorder and that is a very good thing. Keep researching, keep trying.... and again...I wish you the very best....  Evie


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## misummer nightmare (Feb 14, 2003)

Thanks Essence, I hope I didn't sound too defensive, I guess I just feel this disorder is so easily misunderstood that I just wanted to make sure I hadn't been misinterpreted. Just to keep you updated I got a reply from the ibs network which told me to get any info I needed via there helpline, I've been trying all eve but it's constantly engaged...oh well maybe I'll have more luck tomorrow. thinking of investigating tai chi or qi gong...


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## Guest (Aug 17, 2004)

Completely understandable. I feel the same way about the misinformation that runs so rampant about my disorder. I have Dyslimbia.Anything that has the capability of helping us relax is a very good thing....







I personally participate in modern dance stretch 'n flex. You have a remarkably positive attitude. I wish you much success in defeating this disorder...







Evie


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## eric (Jul 8, 1999)

Keep trying the line midwinter, and let me know what they say.You should also try contacting the University Hospital of South Manchester, England and see if they can help with a CBT therapist or recommendation for you.


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## editor (Jun 20, 2004)

Hi midwinter,you mentioned above about the tapes making you feel edgy? Well, I haven't listened to these particular tapes so I can't give you an evaluation on them, *but* I can tell you that in quite a few cases where people are being treated for anxiety and they are using relaxation tapes etc. they also feel edgy, and can have physical feelings, such as tingling in the arms or hands; limbs can feel quite "heavy" and sometimes warm too. This is all *perfectly natural*: it is the body's way of responding to the brain finally starting to unwind and release tension, if you get my drift.







you learned how to be tense, now you are learning to relax. It's going to feel weird because you may have been tense for a very long time. What was it about the tapes that made you feel edgy? Play them through first, without trying any of the suggestions, and that way, your fear and anxiety about whatever is on them, will gradually go down. Don't forget, there's nothing to fear by listening to a tape - *you* control it, not the other way around. You can turn it off anytime you like. If you do start to feel anxious, switch it off, and go make a cuppa tea. Come back to it. Quite a few people have trouble blocking out worrying thoughts that can start when you begin to relax. There are techniques for dealing with that too, so don't worry!Stick with it. Good luck to you


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## Guest (Aug 18, 2004)

Just wanted to add that I was better able to participate in the audio program (Mike's tapes) when I was on the correct medication. Prior to the introduction of the correct medication, it was difficult to even lie still. Sometimes I would even burst into tears during a session, but I didn't let it stop me from using the recordings. Mike once told me (when I mentioned the above to him) that sometimes there are other things going on that need to be addressed. So I hope you can find the help that you may need.Best wishes, Evie


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## eric (Jul 8, 1999)

Midwinter, have you heard from anyone yet?Editor, I would like to copy your post when some of these issues come up.







Essense, hope your doing well.


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## eric (Jul 8, 1999)

By the way, one reason why I was suggesting the CBT for IBS, before the HT and IBS, is working with a CBT therapist on both the IBS issues and the anorexic issues combined, I think would be very benefical.I think working on those to help and then trying the HT just for the IBS would be good approach personally.


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## Guest (Aug 20, 2004)

Thanx for asking, eric... I am doing as well as a person with all of my health challenges can do...







Hope all is well with you also and that married life agrees with you...







Agree with you on the CBT. Not everyone needs meds, but when we do, it's important so that the CBT or HT can work better.It's sometimes amazing what one tiny pill can do to make someone's life so much more positive...







But before I found the right pill, the HT saw me through....


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## misummer nightmare (Feb 14, 2003)

Thank you so much for all your feedback. I finally got in touch with ibs network who were not all that helpful to be honest as the woman I spoke to just kept suggesting I tried swimming! I guess she thought it would be a relaxing form of exercise but it isn't really appropriate for me just yet, she also wasn't very positive about the effect of HT and CBT but she did at least give me the number of holistic resources (unfortunately based quite far away but they might know how I could get in touch with the right people in London. I am already having CBT for my anorexia so am certainly not looking to tackle that with another therapist as I feel this would be very confusing, I am finding my current therapist excellent, the best I've had so don't want to change this (I wouldn't really be allowed to anyway as she was appointed when I came out of intensive care last year). I know I can't separate the two completely but if I do find another CBT therapist I would want it really to be to tackle the IBS...perhaps it might be easier to take the HT approach. Also I get the impression that HT is more likely to help reduce symptoms where as CBT is more geared towards coping with them (though I realise this in turn would reduce them to a degree). I'm just quite wary of the tapes as I did get so frustrated and tense listening to them, quite possibly misdirected anger and irritation I admit, i would love to be able to try them again though, I think I just have a lot of difficulty surrendering to it even though I know it is safe and I'm in control etc, I should probably use the CBT to challenge this. Also I seem to have the symptoms (shouldn't self diagnose but it might be possible) of pelvic floor dysfunction as I seize up (even with D)either completely or mid BM, I find it really hard to realsx the sphincter (perhaps all psychological I don't know), if it is this can HT and CBT help? I know relaxation is key and I am going to try and start tai chi or yoga soon. Thanks again for your responses, it's really good to be getting some support.


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## Guest (Aug 20, 2004)

Hi Midwinter.... I have the "tight sphincter syndrome" as well and in my case the cause is a parasympathetic nervous system malfunction. I have found, however, that certain hormones can help to relax it more, therefore I use topical natural estrogens and progesterone (I am 51). I experienced a bit of the anxiety and agitation with the recordings at first as well, but to relieve the tension, I succumbed to Mike's voice and then I allowed the tears to flow... that helped to relax me... and then I was better able to follow through with the sessions.For me, however, medication was necessary in order for me to be able to fully relax and take advantage of the benefits of the HT.Please don't feel defeated if you happen to be one of the people who might need medication to enhance your life. Sometimes taking a corrective medication for the first time can be like putting on glasses for the first time.... where you can finally experience what it feels like to feel well. Chemistry can make a huge difference in how we feel and even in how we think.Keep us posted on your progress. Remember that we're all here for support when you need it...







Evie


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## misummer nightmare (Feb 14, 2003)

Thanks essence, I would be willing to try meds but as I said unfortunately my weight is too low they tell me and they don't seem to have a clue as to which meds help ibs, apparently the gastros wont take me seriously until I'm a normal weight as they don't know whether the symptoms are a consequence of it, hopefully they'll give me a proper assessment once i reach a normal weight. It's interesting you mention hormones as I of course am still a mess in that area, having not menstruated for so long means im osteoperotic but I didn't realise the effect it could have on the gut. I thought it was seratonin that affected it. Although I've put on 20 pounds I still am only up to about 75 pounds and need to be at least 110 before my hormones kick back in sufficiently. Do you think getting to a level where I have enough oestrogen to get periods will help this 'tight sphincter syndrome'? Also does the HT have a beneficial effect on this particular aspect? Take care, MW


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## Guest (Aug 22, 2004)

Hi MW,Serotonin does affect the gut. It's a major player. Eric can tell you all about that and how the brain and the enteric nervous system are connected.Hormones also affect the gut. In fact hormones can affect just about anything....







It's my understanding that brain chemistry is also somehow linked to hormones with natural progestone being a major player.And stress, trauma, abuse or illness can affect all of the above.I don't know if normal levels of estrogen would affect your sphincter or not. My experience is that a few years ago I had plenty of estrogen and mine was a lot less tight than it is now. These days, since my estrogen levels have decreased, even a finger in there is painful.When it comes to evaluating HT, I can only offer you my own experiences with it... which have been very positive. It initially helped my anxiety. It also helped my self-esteem. The relaxation it helped me achieve was a real bonus. Again, I am one who requires medication to enjoy its full benefits. Mike Mahoney is the one to talk to about whether or not HT would have a beneficial effect on a tight sphincter, but I suspect that HT's scope is far-reaching and I often read good things about it in newspapers, magazines....I've even seen it touted in a publication circulated at the hospital where I work. Relaxation therapies of any type are beneficial for most everything. I hope your doctors can reach some conclusions for you very soon....  Hugs for you,Evie


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## misummer nightmare (Feb 14, 2003)

Thanks Essence, maybe I should email or call mike and see what he says. I know relaxation is a huge problem for me and I have knoe doubt that working on it would help me enormously, at the moment it's a question of getting my anorexia to be quiet for long enough to allow me to do it as right now it's fighting for it's life as it knows I'm fighting for mine. I really appreciate how supportive you have been, it means a lot to me. Take care, MW


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## Guest (Aug 22, 2004)

Hi MW,When I sense that someone is in distress, I automatically go into "help mode" cuz I've gone through a lot of distress in my life... especially in recent years....and it can be very emotionally painful...especially if someone has a limbic system disorder like I have. That's why I recognized the link between what I have and what you have.It may be that you need something to help you relax in order for the anorexia to improve? I know you said your doctor didn't want to put you on any medications just yet, however I guess if it were me, I might press them a bit and suggest that to my doctor.Only a doctor can diagnose/guide/prescribe for you. I can tell you that taking anticonvulsant medication to replenish levels of Valproic Acid in my brain quelled my anxiety by about 90% and decreased my gut motility (lessened the "D"). It also put 20 pounds on me. Now I wish I would stop gaining weight







cuz I'm gettin' chubby!Something else that helps me is eating several smaller meals a day. An already aggravated gut doesn't handle large meals very well.Wish there were some way to better ease your discomfort.... Do hang in there.... think positive thoughts about yourself.....engage in any type of activity that helps you to relax or feel better. Know that you are not alone and that you are loved.Sending you prayers...  Evie


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## editor (Jun 20, 2004)

*Eric*yep, that's fine! Please feel free to use it.


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## eric (Jul 8, 1999)

Thanks Editor, it is very helpful.Midwinter, I am sorry I had a small exteernal family crisis this week into the weekend.To bad the net work was not of more help.Why don't you use the cbt like you said to challenge the HT issue. Also maybe the yoga and other relaxation issues will get you to relax enough for the HT. There is something called relaxation resistence.for the pelvic floor muscle HT would help relax you and hence benefit, but there is also biofeedback for that. The tapes however target all IBS symptoms and the mind body connections.Have you read Dr Bolens book? It has work sheet and is a program in a book basically.Barbara Bradley Bolen, Ph.D.bbolen###optonline.netSeptember 5, 2002COGNITIVE BEHAVIORAL THERAPY FOR IRRITABLE BOWEL SYNDROMEThere is an old saying that if you give a child a fish, you feed that child for a day, but if you teach a child to fish, they are fed for a lifetime. In accordance with this old proverb, Cognitive behavioral therapy (CBT) is a form of psychotherapy that strives to actively teach people skills and strategies that they can use to help themselves feel better. A considerable amount of research indicates that CBT is effective in helping to reduce the symptoms of Irritable Bowel Syndrome.Many people wonder how psychotherapy can help IBS if IBS is a physical disorder. One of the major triggers that can set off or exacerbate IBS is stress. In addition, IBS is a very stressful disorder to live with. CBT provides an individual with tools for combating stress, reducing the anxiety response and thus calming the GI system.The cognitive therapy part of CBT helps individuals to identify, challenge and replace unhealthy thought patterns. When we are thinking clearly, we are able to deal with the world in a calm, rational manner. However, our thinking often gets distorted, due to our personalities, our past history, our emotional state or lack of information. When thinking gets distorted it can lead to excessive emotional reactions. For an individual with IBS, these thought distortions may lead to an anxiety response that can trigger symptoms. For example, if a person with IBS thinks ï¿½My stomach is rumbling. Uh, oh! I know I am going to be sick. What is I canï¿½t make it to the bathroom? This is terrible!ï¿½, that person is going to experience anxiety and perhaps set off the very symptoms they are afraid of. If instead, the person thinks, ï¿½Just because my stomach is making some noise does not necessarily mean I am going to have symptoms. I will just focus on what I am doing and see what happensï¿½, that person will remain calm and be less likely to stimulate their digestive system.The behavioral aspect of CBT involves skill training. Relaxation techniques, including deep breathing skills and progressive muscle relaxation, help the individual to reduce the physiological symptoms of anxiety. An anxiety reaction can be likened to a home security alarm. Relaxation techniques send the message to the body that there is no emergency and that the alarm can be shut off. CBT for IBS may also include skill training in assertion and anger management, as research has shown that IBS patients often have difficulty in these areas.IBS can wreak havoc on a personï¿½s quality of life. CBT helps IBS sufferers to regain a sense of control over their life. With the skills gained in CBT, one no longer needs to be a passive victim of this disruptive disorder, but can now actively use strategies which are effective in reducing the frequency, intensity and duration of IBS symptoms. Barbara Bradley Bolen, Ph.D.bbolen###optonline.netAuthor of:Breaking the Bonds of Irritable Bowel SyndromeNew Harbinger Publications (2000)You sound very on target with your posts and that is good.How are you doing at the moment? And sorry it took so long to reply.


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## misummer nightmare (Feb 14, 2003)

Thanks for your feedback eric, I hope whatever family issues arose are easing. I spoke to someone at holistic resources and gave them a breif explanation of my situation and history and they felt very strongly that the ibs would be very difficult to treat with the CBT and HT while my anorexia is still so strong, i have to admit that the anorexia is more important to tackle as it's the one that is life threatening but equally I would feel more able to fight it (which I am doing anyway) if the gut symptoms weren't so distressing. I actually have the Breaking bonds book but really struggled with it as the main source of my stress at the moment are my battle with the eating disorder and working through its origins and triggers, both of which are unavoidable so of course I can't eliminate the causes of stress however I could start to work independently on the acceptance side of it, and challenging my reactions to my symptoms. All very easy to do intellectually, it's reconciling this with the emotional side (something I struggle with constantly in CBT, I have no problem working things through rationally but I can rarely truly believe it).I'm encouraged that you say HT can help with the pelvic floor tension as I know that the doctors refuse to treat anorexics with biofeedback (at least in my exp). IS the pelvic floor issue psychological then? Will work on trying relaxation through yoga or tai chi as I have to admit I thonk you're right about the relaxation resistance. Thanks again MW


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## eric (Jul 8, 1999)

The pelvic floor issues can be both psychological and a muscle issue, more a muscle issues, but some people can learn to relax it and hence help it. Being relaxed in general may help it. Some people tense up while going and that makes it worse.I understand where your coming from.lets try this, lets look at some basic relaxation techniques to try first. They will help in their own right.try doing this at the end of the article for over two weeks. It does not work effectively right away, although it can helps some right away.with permission from the UNC and the author1USING RELAXATION:COPING WITH FUNCTIONAL GASTROINTESTINAL DISORDERSKenneth R. Jones, Ph.D.Research Assistant Professor of Medicine/Clinical PsychologistSteve Heymen, MSInstructor of Medicine/Certified Biofeedback TherapistTEN RELAXING BEHAVIORSRelaxation training is a integral component of behavioral therapies for managing chronic pain, promotinghealth, and helping patients cope with life-threatening illness such as breast cancer. Relaxation can alsoassist in managing functional GI disorders.HOW CAN RELAXATION HELP?Research has shown that relaxation provides several health benefits including: decreasing excess arousalproduced by worry or anxiety, managing insomnia, buffering the adverse physiological responses tostress, and increasing pain tolerance while decreasing some of the symptoms associated with chronic pain.Relaxation training is also a vital part of any stress management program and is a component of manycognitive-behavioral treatment programs for problems such as headache, depression, anxiety, andphobias.Many researchers and health professionals believe that relaxation provides two important functions1) as a coping skill that can be used immediately when a person is stressed, overly aroused, or inpain, and(2) by preventing some of the damaging effects of stress.Daily practice of relaxation lowers arousal that is associated with wear and tear on the body. Regular useof relaxation enables one to calm the body before beginning stressful activities and has been associatedwith improvements in the immune system as well as improved survival of cancer patients. Thus, dailypractice of relaxation makes a person generally more relaxed, better prepared to manage daily demands,and better able to buffer the long-term effects of stress, while also providing a tool to use when things getout of hand.For individuals with functional GI disorders, relaxation appears to help by dampening the pain, managingthe arousal naturally associated with physical distress, empowering the patient with self-help skills, andmanaging irritability which is a very common consequence of chronic pain.WHAT IS RELAXATION?The skill of achieving a deep state of relaxation has been pursued throughout much of recorded historyand is a key element in many religious, cultural, and philosophical traditions. Contemporary healthscientists have attempted to specify what relaxation is and identify how to teach people to relaxeffectively. It is helpful to view relaxation from the perspective of three integrated systems in the body:the brain, the skeletal muscle system, and the autonomic nervous system.2THE BRAIN/COGNITIONuring and following relaxation, individuals typically report experiencing less rapid thinking and anincreased ability to focus thoughts and maintain concentration. The quality of thought is also reported tobe calm and restful in nature. Herbert Benson, MD, an accomplished researcher of the healthy effects ofrelaxation, describes the thinking state of relaxation as a "passive attitude," perceived as a peacefulwillingness to just let thoughts flow in a natural, non-directed or non-controlled manner.Relaxation produces a particular pattern of bioelectrical brain activity as recorded in theelectroencephalogram (EEG). The EEG of non-relaxed individuals shows relatively low voltage highfrequency brain activity that is not synchronized. When deeply relaxed, the dominant frequency of brainnerve firings slows, portions of the brain appear to fire in a synchronized fashion, and a high voltage slowfrequency pattern can be recorded. We refer to this EEG pattern as alpha activity. Everyone producessome alpha activity prior to falling asleep. Difficulty producing alpha activity is associated with sleeponset insomnia. Because we can record alpha and give people feedback on how well they are producingalpha states, we can use alpha feedback as one way to teach relaxation skills (see biofeedback, below).THE MUSCLES:When relaxed, there are two changes in muscular activity. First, relaxed people are very still. If they moveat all, they do so slowly and gently. Second, muscle tone is greatly diminished when people relax. Muscletone is the background level of muscle tightness in between overt muscle movements. Many of us getsore, aching muscles in our lower backs and shoulders or develop muscle tension headaches when muscletone is too high for too long.THE AUTONOMIC NERVOUS SYSTEM:The third system that changes with relaxation is the autonomic nervous system. This is the part of thenervous system outside of our brain and spinal cord that controls digestion, blood circulation, and otherour basic biological processes. The Latin-based word "autonomic," literally translates in English to"automatic." This nervous system controls parts of our body that we do not normally have to attend to,like when our heart beats or the level of activity of our gastrointestinal system. This autonomic nervoussystem has two branches, the sympathetic nervous system and the parasympathetic nervous system. Thesympathetic and parasympathetic systems activate different parts of the body in different ways, but theytend to act like the two sides of an old-fashioned scale -- when the sympathetic system is activated, theparasympathetic system is less activated and vice-versa.Generally, the sympathetic nervous system is activated when you are challenged, stressed, or faced with adangerous situation. When we are anxious, frightened, or in pain, we know that our heart beats moreforcefully and races, our palms sweat, and we suddenly feel very awake and alert. By contrast, we tend tobe more parasympathetically activated when out of danger and environmental demands are low. Underparasympathetic activation, the organs take care of "vegetative" or housekeeping functions such asdigesting meals, converting blood sugars for long-term storage, and moving nutrients to cells whilemoving waste away.Breathing is an interesting physiological process as it is controlled voluntarily and by the autonomicnervous system, such as when we sleep, lose consciousness, or do not need to voluntarily regulate ourbreathing for activities such as speaking. Research studies suggest that many parts of the autonomicnervous system tend to follow the activity of breathing. Under sympathetic activation, breathing tends tobe rapid, shallow, and less rhythmic. During relaxation and parasympathetic activation, breathing is slow,3deep, and has a regular rhythm. Because one can voluntarily change breathing patterns and because theautonomic nervous system tends to mimic what is going on with breathing, a relaxed breathing patterncan be a successful way to gain control over automatic physiological processes.These three systems, the brain/cognition, the muscles, and the autonomic nervous system, are integratedby brain centers including: the limbic system (governing emotions), the hypothalamus (controlling basicbiological/behavioral processes), and the reticular activating system (regulating arousal). The threesystems tend to work in a coordinated fashion. When an individual changes the pattern of responding inone system, this affects the other systems. Thus, if one becomes very still and reduces muscle tone, thereis a tendency for the brain and autonomic nervous system to generally reflect relaxation. Methods ofproducing relaxation tend to focus on one system, combinations of these systems, or all three.KEY ELEMENTS IN LEARNING TO RELAX:Like any skilled act, relaxation skills are developed through practice. For a patient to show any lastingbenefit from relaxation training, research has indicated that a minimum of four training/therapy sessionsis critical. Researchers have found that patients will continue to show skill development over the first 10relaxation training sessions, but generally, patients do not show additional benefit from more than 10sessions. Regular practice of relaxation appears to be critical in learning how to become deeply relaxedand producing health benefits from relaxation. If one has difficulty in becoming relaxed, special coachingor individual tailoring of a relaxation technique may be required (see Seeking Professional Assistance,below).WHICH METHOD IS BEST FOR ME?There are subtle differences produced by various methods of teaching relaxation. Nevertheless,researchers have repeatedly found that any systematic program of relaxation appears to produce positivechanges in physiologic and psychological states for most people. Thus, one should choose a relaxationtraining program that feels comfortable to them. Various training programs are available through collegecontinuing education programs such as yoga, transcendental mediation, or self-hypnosis. Many self-helpbooks, guided relaxation tapes, or music-based relaxation recordings are also available. Biofeedback canalso be a very powerful relaxation technique. Biofeedback is a psychological self-regulation techniqueusing feedback from one's body reflected through a computer. Several studies have also shown thathypnosis is helpful to irritable bowel syndrome patients. Hypnosis therapies for functional GI disordersinclude both relaxation and suggestions for how to cope with functional GI problems.THE BASICS:Roger Poppen has done a good deal of research attempting to identify in the most basic way, what one hasto do to produce relaxation. He has broken this down into10 basic behaviors that you may want to try (seebox).SEEKING PROFESSIONAL ASSISTANCE:Health psychologists and other behavioral medicine specialists regularly teach relaxation skills to helpindividuals cope with medical problems or reduce health risks. A health psychologist can also assist thosewho have difficulty learning to relax when a more individualized relaxation program is required. If youhave difficulty finding a health psychologist, ask your health care providers for a referral, call your statepsychological association, or contact a behavioral pain management program.4TEN RELAXING BEHAVIORS:Most individuals prefer practicing relaxation in a recliner chair in a quiet room (TVoff).Head: The head is motionless and well supported by a pillow or recliner chair, and thehead is centered with the midline of the body.Eyes: Eyelids are lightly closed with smooth appearance and there is no motion of theeyes (one may want to focus on an object low and distant in the room before closingthe eyes).Mouth: The lips are parted at the center of the mouth and the front teeth are slightlyparted.Throat: There is an absence of motion and the neck centered with midline.Shoulders: Shoulders are rounded (dropped) and symmetric.Body: The body is still. The torso, hips and legs are symmetric in regard to midline.The muscles are still and the body is fully supported by the chair.Hands: The hands should rest on chair arms or lap. The fingers are still and should begently curved.Feet: The feet and toes are still. The toes are pointed away from each other such thatthe feet form a V.Quiet: You should make no vocalizations or loud respiratory sounds.Breathing: Breathing pattern should be slower than when aroused, deep, and regularin rhythm.After getting into a relaxed state, just simply remain still and enjoy this state for10-20 minutes. If you feel yourself becoming tenser, review the list of relaxedbehaviors. If you have trouble with worrisome thoughts, try focusing on yourbreathing and thinking about breathing out tension and breathing in deeperrelaxation.Adapted from Poppen, R (1988), Behavioral Relaxation Training & Assessment, New York: PergamonPress. http://www.med.unc.edu/medicine/fgidc/using_relaxation.pdf One thing about all these methods is they require the long term effort to do them or they don't work.Try doing this for a couple of weeks and see how it goes for you. It will help later with either CBT or HT also.


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## eric (Jul 8, 1999)

also on relaxation resistenceby Thomas J. Schumacher, Psy. D., R-CSWMore About Thomas...ï¿½A perpetual holiday is a good working definition of hellï¿½ï¿½ George Bernard Shaw, (1856-1920) Our widespread inability to relax is rarely acknowledged. Few of us are comfortable admitting that we have a tremendous amount of difficulty in being able to relax. Come Monday morning, when asked about your weekend, you reflexively spout out that is was ï¿½great.ï¿½ It is equally as common for us to list our relaxation activities (i.e., we were at the beach house, out on the boat, etc., etc.) as though these activities clearly imply that we truly enjoyed them and we were readily able to relax. However, relaxation is usually about a state of ï¿½beingï¿½ and not about a state of ï¿½doing.ï¿½ Therefore, no list of relaxation activities guarantees ï¿½beingï¿½ in a state of relaxation. Most people view being able to relax as simply mind over matter. Should someone tell you that they were unable to relax, you might listen sympathetically but also might feel that the person was just not exercising enough control over himself or herself. Often, we see the inability to relax as a sort of weakness on the part of the person. In addition, many people also believe that relaxation is a natural state. You just take time off, do things you like to do, and relax. If there is a barrier to relaxation, it is believed that it is linked to stress ï¿½ too much work, too little money, too little time, and too many responsibilities. Many believe that if they had both more time and more money, then relaxation would be sure to follow. News Flash: All of the above beliefs are false ï¿½ relaxation is an unnatural state!To understand this you need to look at human brain development and observe some basic elements in nature. One major feature here is the instinctual drive for survival. Nature gives all animals some protection against its natural predators. But, in order to survive, surveillance is required. The bird that decides to take a nap at the base of the feeder might be easy prey for the local cat. The chipmunk that doesnï¿½t keep a close lookout will fall prey to a hawk. The unpleasant reality is that in nature, most everyone is trying to eat everyone else. ï¿½Eat or be eatenï¿½ is one of the primary laws out there. Although human beings are capable of rational thought, our brains developed in an evolutionary way. Part of early brain development (often called the reptilian brain) is where primitive impulsive and archaic behaviors reside. We can often override these primitive impulses, but they remain intact and emerge episodically through life. Therefore, our natural state is to maintain our sense of alertness in order to protect ourselves. Relaxation implies that we let down this antenna system. It means turning off the radar so that we will not be attuned to incoming missiles. The natural state is to maintain round the clock radar. Our built in radar system does not come with an on ï¿½ off switch. It is hard wired and always working. Hence, when we try to relax, we are often frustrated. You may have a planned day off and you want to relax. Although you have created the ï¿½rightï¿½ environment, you sit there trying to relax while your radar system fills your head with all kinds of stuff. The next day, rather than feel refreshed, you feel depleted. Remembering that relaxation is an unnatural state, recognize the bind you are in and relieve yourself of the pressure and the guilt you may feel as a result. Rather than help you to relax, pressure and guilt only serve as barriers. Many of you feel that you are supposed to be relaxed and try to drive yourself into a state of relaxation. Pressuring yourself to relax will guarantee your inability to relax. Relaxation only comes when allowed; it cannot occur when forced. Similarly, guilt is both unwarranted and non-productive. So, how do you relax? Can anything be done to achieve a relaxed state? The answer is a conditional ï¿½yesï¿½. It can be done. However, your expectations need to be realistic. Although you can learn to relax, you probably will not be able to do it ï¿½on commandï¿½ and ï¿½at will.ï¿½ Some days it will go well. Other days, for a variety of reasons, it will not.The key to relaxation is to find ways to temporarily fool the reptilian brain into going on vacation. If it remains at its sentry post, then you will be too aroused and defended to achieve a state of relaxation. Next, there are a lot of individual differences in what will work. Below are just a few of the more common methods to achieve a state of relaxation. None are universal. You will need to experiment to see what works for you. And, even then, it may not work consistently. Bottom line: you must pick and choose techniques that are suited to your needs, temperament and lifestyle.1) Music: ï¿½ For many people, music is effective. It bypasses the sensor and can draw you in, in a meaningful and pleasurable way. Most all cultures have rituals based in music that have evolved over many centuries. The key here is to focus on what music evokes in you. The idea is to feel something. Numbness is not equivalent to relaxation. If any activities are making you feel numb, then you are narcotizing yourself, not relaxing. 2) Meditation: ï¿½ Meditation has been a staple for relaxation for quite some time. This technique is about focusing your attention. The problem with it is that its results are subtle; it takes a good deal of time and effort, and is easy to abandon. Meditation is not for everyone. But, it is worth a try. Herbert Bensonï¿½s ï¿½Relaxation Responseï¿½ may be a suitable beginning guide as is ï¿½The Relaxation and Stress Reduction Workbookï¿½ (New Harbinger Publications). 3) Religion: ï¿½ Religion, if it provides you with a sense of sanctuary, often achieves a relaxed state. The key here is your sense of safety and security. If you feel you achieve this feeling, then religion may be one of your avenues to relaxation. 4) Move Your Butt: ï¿½ Exercise, if not compulsively driven, can help relieve some of the physical tension that builds up in the course of a day. Walking, jogging, running, bicycling, swimming, or playing tennis relaxes muscles and relieves tension. Give yoga a try ï¿½ itï¿½s a soothing way to exercise. Note: some find the relaxation in the aftermath of the exercise rather than during the exercise. 5) Touch: ï¿½ Touch is the only universal relaxer. It bypasses all of the defenses and is actually vital to survival. If you are not getting enough touch, then achieving a relaxed state will be very difficult. But there are some caveats here. The main one is that there are two kinds of touch. One is a ï¿½giving touchï¿½ in which you feel someone is giving something to you. The other is a ï¿½taking touchï¿½ in which you feel someone is taking something from you. The ï¿½giving touchï¿½ is essential and productive one. The ï¿½taking touchï¿½ has nothing to do with the spirit of touch. Do not be a party to ï¿½taking touchï¿½. It will only get you father away from where you need to be. ï¿½Giving touchï¿½ leads to genuine intimacy and relaxation. Sensual and erotic touch is a legitimate part of ï¿½giving touchï¿½. ï¿½Taking touchï¿½ turns the people into objects. The intimacy is counterfeit and will only re-energize the sensor. Most everyone can instinctively tell the difference between the two. 6) Relax Your Muscles: Learn about progressive muscle relaxation, s-t-r-e-t-c-h your muscles on a regular basis, or treat yourself to a massage, all great ways to relax muscles and enhance feelings of relaxation. 7) Get Practical: Learn about the benefits of deep breathing, visualization techniques, or picture yourself relaxed through guided imagery. Cut down on caffeine (a potent central nervous system stimulant), get plenty of rest (sleep deprivation compromises your immune system, reduces your ability to cope with daily stressors, clouds your cognitive functioning, makes you sound stupid, and increases irritability. Use alcohol in moderation, when the ï¿½highï¿½ wears off, youï¿½ll feel drained ï¿½ not relaxed. 8) Get Smart: Learn to say ï¿½noï¿½ to excessive demands on your time and energy that increase your stress level, deal with and express your anger/rage, learn to manage your time effectively, and rejuvenate yourself through a hobby ï¿½ all wayï¿½s for you to cognitively and socially nurture yourself.9) Get Connected: Develop a social network. An influx of new research suggests that emotional support helps protect people against the ill effects of stress. Consistent contact with supportive people, community organizations, and/or satisfying causes, all act as a built-in buffer to stress. Therefore, make your world larger than your spouse, lover, family and/or your immediate circle of friends. Carve out time for each and nurture these attachments and they will nurture you. 10) Too Bad If They Canï¿½t Take a Joke: Have a good laugh! Laughter deepens your breathing, lowers your blood pressure and releases endorphins, stimulating the pleasure center of the brain. At the same time, studies show, laughter seems to decrease the production of stress hormones from the adrenal glands. http://www.ec-online.net/Knowledge/Article...tionresist.html


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