Depression and Diabetes

Women who have diabetes and depression have a significantly higher risk for all-cause mortality and cardiovascular disease (CVD), new research suggests.

In a cohort study of more than 78,000 women older than 54 years, investigators found a 35% increased risk for any death for those with diabetes only, a 44% increased risk for those with depression only, and twice the risk for those with both compared with their counterparts with neither condition.
When considering only deaths from CVD, women with diabetes had a 67% increased mortality risk, women with depression had a 37% increased risk, and women with both had more than 2.7 times the increased risk.
"Our findings suggest that these 2 conditions of depression and diabetes, which often go hand in hand, create a vicious cycle or what I call 'a double whammy' in terms of health outcomes," investigative team member Frank Hu, MD, PhD, professor of nutrition and epidemiology at the Harvard School of Public Health in Boston, Massachusetts, told Medscape Medical News.
"So I think it's very important for patients and clinicians to address these conditions at the same time in terms of prevention and management," he added.
The study is published in the January issue of Archives of General Psychiatry.
Coexisting Conditions Common
Symptoms of depression affect between 20% and 25% of patients with diabetes — which is "nearly twice as many" as individuals without diabetes, investigators note.
"It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients, and isolation from the social network," they write.
Although previous research shows depression and diabetes are each associated with an increased risk for mortality, "data evaluating the joint effects of these conditions on mortality are sparse."
For the study, researchers evaluated data from the Nurses Health Study, a cohort of 78,282 female registered nurses (97.6% white) between the ages of 54 and 79 years, who responded to a questionnaire.
Depression was determined by self-report, antidepressant use, or a score of 52 or less on the 5-item Mental Health Index (MHI-5; indicating severe depressive symptoms). Type 2 diabetes was confirmed by a self-reported supplementary questionnaire.
Exclusion criteria included a history of gestational, type 1, or secondary diabetes and missing information on antidepressant use, depressive symptoms, or diagnosis.
All participant information was assessed at baseline in 2000 and at 6-year follow-up.
Higher Mortality Rates
Results showed that 14.2% of the women had depression only, 5% had diabetes only, and 1.3% had both. At follow-up, 4654 total women had died from any cause; 979 of these deaths were from CVD.
Women who had both diabetes and depression had lower MHI-5 scores and physical activity levels, had higher body mass indexes, and were less likely to have spouses at baseline than those who had neither condition or either alone. They also had higher baseline rates of hypertension, heart disease, stroke, or cancer.
In addition, "the prevalence of depression in participants with diabetes (20.5%) was higher than that in the individuals without diabetes (15.1%)," the investigators write.
Age-adjusted relative risks (RRs) for all-cause and CVD mortality were significantly higher for women with depression only and diabetes only compared with those with neither condition and were substantially higher for those with both.
Table 1. Age-Adjusted RRs of Death According to Diabetes and Depression Status
Mortality Type Depression Only, RR (95% CI) Diabetes Only, RR (95% CI) Both Conditions, RR (95% CI)
All cause 1.76 (1.64 – 1.89) 1.71 (1.54 – 1.89) 3.11 (2.70 – 3.58)
CVD 1.81 (1.54 – 2.13) 2.67 (2.20 – 3.23) 5.38 (4.19 – 6.91)
CI = confidence interval; CVD = cardiovascular disease; RR = relative risk
"These associations were attenuated after multivariate adjustment for other demographic variables, body mass index, smoking status, alcohol intake, physical activity, and major comorbidities (including hypertension, hypercholesterolemia, heart diseases, stroke, and cancer) but remained significant," the investigators write.
After these adjustments were made, women who had both conditions were again found to have the highest RRs for all cause and CVD mortality.
Table 2. Multivariate RRs of Death According to Diabetes and Depression Status*
Mortality Type Depression Only, RR (95% CI) Diabetes Only, RR (95% CI) Both Conditions, RR (95% CI)
All cause 1.44 (1.34 – 1.54) 1.35 (1.21 – 1.51) 2.07 (1.79 – 2.40)
CVD 1.37 (1.16 – 1.62) 1.67 (1.36 – 2.05) 2.72 (2.09 – 3.54)
CI = confidence interval; CVD = cardiovascular disease; RR = relative risk
*Multivariate model plus major comorbidities.
"Furthermore, the combination of depression with a long duration of diabetes mellitus (>10 years) or insulin therapy was associated with a particularly higher risk of CVD mortality after multivariate adjustment (RRs, 3.22 and 4.90, respectively)," the study authors note.
"Considering the size of the population that could be affected by these 2 prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic diseases, such as diabetes," they add.
"I think this study has important clinical implications in addressing diabetes control and depression prevention," said Dr. Hu. "The important question is, 'How can clinicians better help patients deal with both conditions at the same time?'
"Patients with diabetes should watch out for any depressive symptoms or signs and should also receive psychosocial support to help them reduce stress associated with diabetes management. And those with depression should have their blood sugar more closely monitored."
Dr. Hu noted that he would like to see future studies addressing potential mechanisms of depression plus diabetes. "Why do these 2 conditions tend to go together? And why is the combination of them together associated with such a high risk of mortality? I think both biological and behavioral factors contribute. But I think we need more detailed studies to look into this."
Confirmatory Findings
"I think this study is valuable for its overall perspective, but I'm not sure it's different than what you would find with other chronic diseases, except for a couple things that actually aren't mentioned in the paper," Gerald Bernstein, MD, from the Friedman Diabetes Institute at Beth Israel Medical Center in New York City, told Medscape Medical News.
"People with diabetes have elevated blood sugar. And one of the things not addressed in this study was the level of control of the blood sugar in these nurses that were looked at. The researchers talk about medication and duration but not whether it was well or poorly controlled," explained Dr. Bernstein.
He noted that although it might not be possible now, "it would be nice" if the investigators could go back and provide a graph comparing blood sugar control and the frequency of depression.
"The other interesting thing was that the depressive quality increased progressively with the complexity of treatment. So 'no medication' was one level, oral medication was at another, and people who took insulin actually had the worst. This makes sense because many people, though they shouldn't, think that insulin is a marker that they're doomed and that it's an end-stage intervention. So I think the documentation of this as a reality is important," said Dr. Bernstein.
He explained that the Diabetes Benefit Program he directs at his institute is aimed at diabetes educators, which include social workers/psychologists "because it's important to understand the role of depression in this disorder."
"It's 1 thing to teach about exercise, nutrition, and how to take care of medication, but we make sure we don't ignore the psychodynamics of this disease. It's a multilevel intervention aimed at preventing complications."
Overall, Dr. Bernstein noted that this study "is not a new observation. The importance was the sheer volume of people that they were looking at. So there's value in this observation that is confirming what other people have seen in the past."
The study was funded by grants from the National Institutes of Health and from the National Alliance for Research on Schizophrenia and Depression. The study authors and Dr. Bernstein have disclosed no relevant financial relationships.

General Anesthesia

Despite what anesthesiologists may tell surgery patients, the brain under general anesthesia is not "asleep," it is placed in a reversible drug-induced coma, according to 3 neuroscientists who reviewed and synthesized the latest research in general anesthesia, sleep, and coma.
Their review, 3 years in the making, appears in the December 30 issue of The New England Journal of Medicine.
"Anesthesiologists use the term 'sleep' so as not to scare patients with the word 'coma,' " Emery N. Brown, MD, PhD, from the Department of Anesthesia, Critical Care, and Pain Medicine at Massachusetts General Hospital and Harvard Medical School, Boston, pointed out in correspondence with Medscape Medical News. In reality, however, general anesthesia is a type of coma.
Dr. Brown's coauthors on the review are Ralph Lydic, PhD, from the University of Michigan, Ann Arbor, whose expertise is sleep medicine, and Nicholas D. Schiff, MD, from Weill Cornell Medical College in New York City, who specializes in recovery from coma.
"This review was prompted by a recognition that common brain circuit mechanisms may underlie aspects of general anesthesia and recovery from coma and that thinking through the links across these phenomena and their distinction from the natural processes of sleep would reveal important insights," said Dr. Schiff .
The realization that general anesthesia and coma have more in common with each other than differences "is very exciting," Dr. Schiff said, "because it gives us new ways to understand each of these states.
"Measuring brain circuit mechanisms may lead to greater diagnostic accuracy and targeted therapeutic strategies for predicting and supporting the recovery process from coma after severe brain injuries," he added. Monitoring brain function under general anesthesia may also help in developing new sleep aids.
Nothing Mysterious About the Anesthetized Brain
The scientists note in their article that there is substantial overlap between the electroencephalograms of patients in coma and of patients during general anesthesia. "The [electroencephalogram] of the states of coma recovery can resemble those of the awake, general anesthesia, or sleep state, depending on how extensive the brain injury is and where the patient is in terms of recovery," Dr. Brown noted.
The team also notes that anesthetic drugs induce unconsciousness or alter arousal through actions at multiple sites in the cerebral cortex, brainstem, and thalamus.
Contrary to what is commonly stated, how these drugs create the state of general anesthesia "is not mysterious," Dr. Brown explained, and "there are multiple mechanisms even for a single drug."
General anesthesia, the scientists say, is functionally equivalent to brainstem death, and perhaps explains why some patients do not fully recover consciousness for several hours after general anesthesia, as well as why postoperative cognitive dysfunction could persist in elderly patients for several months afterward.
"One thing which is evident regarding recovery from general anesthesia is that it tracks the return of function in the brainstem from bottom (respiration) to top (eye-movements and arousal centers)," Dr. Brown noted.
Dr. Brown, Dr. Lydic, and Dr. Schiff hope their article will facilitate more informed discussions among anesthesiology, sleep, and coma researchers and lead to new approaches to creating the state of general anesthesia, sedation, and sleep, as well as new approaches to facilitating coma recovery.
They hope it will also lead to better education of the public about general anesthesia.
This research was supported by the National Institutes of Health, the James S. McDonnell Foundation, Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medicine, and University of Michigan Department of Anesthesiology.

Cow-Milk Formula-Fed Infants May Have Accelerated Weight Gain

Infants fed cow milk formula (CMF) have accelerated weight gain, whereas infants fed protein hydrolysate formula (PHF) have normative weight gain, according to the results of a randomized controlled trial reported in the January 2011 issue of Pediatrics.
"Infant formulas differ considerably in composition and sensory profiles," write Julie A. Mennella, PhD, from the Monell Chemical Senses Center in Philadelphia, Pennsylvania, and colleagues. "In this randomized study, we examined whether healthy infants fed an extensively ...PHF would differ in feeding behavior and growth from those fed ...CMF."
Infants were randomly selected to feeding with CMF (n = 35) or PHF (n = 29) from ages 0.5 to 7.5 months. Infants were weighed, measured, and then videotaped while being fed their assigned formula monthly during the 7-month study period. Using World Health Organization growth standards, the investigators calculated anthropometric z scores, and they compared trajectories for growth measures and formula acceptance using multilevel linear growth and piecewise mixed-effects models.
Although PHF-fed infants had significantly lower weight-for-length z scores across ages 2.5 to 7.5 months vs CMF-fed infants, length-for-age z scores were similar in both groups, suggesting that group differences could be attributed to gains in weight rather than length. Compared with infants fed CMF, those fed PHF also had significantly slower weight gain velocity. Monthly evaluations across the study period revealed that infants fed PHF rather than CMF consumed less formula to satiation. At all ages tested, infants' acceptance of formula was similar in both groups, based on maternal ratings.
"[Z]-score trajectories indicate that CMF-fed infants' weight gain was accelerated, whereas PHF-fed infants' weight gain was normative," the study authors write. "Whether such differences in growth are because of differences in the protein content or amino acid profile of the formulas and, in turn, metabolism is unknown."
Limitations of this study include small sample size and inability to determine the exact mechanisms underlying the different weight-gain trajectories between CMF and PHF.
"Longer-term effects of hydrolyzed protein diets, which are relatively new in the human food supply and are growing in use, also need to be investigated," the study authors conclude. "Because dietary and nutritional programming can have long-term consequences in terms of later development of obesity, diabetes, and other diseases, it is imperative that we learn more about the long-term consequences of the early growth differences caused by environmental triggers, such as those associated with infant formulas, and how and why they differ from breastfeeding, which is the optimal mode of feeding."
The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health supported this study. Mead Johnson Nutritionals supplied the formulas. The study authors have disclosed no relevant financial relationships.

Positive Psychology

Tough economic times are the perfect setting to begin using positive psychology to your advantage, says a new report from Harvard Medical School. Positive Psychology: Harnessing the power of happiness, personal strength, and mindfulness is a guide to the concepts that have made "Positive Psychology" the most popular course at Harvard University, and teaches how to put positive emotion to work in your life.
Positive emotions have been linked with better health, longer life, and greater well being in numerous scientific studies. On the other hand, chronic anger, worry, and hostility increase the risk of developing heart disease, as people react to these feelings with raised blood pressure and stiffening blood vessels. A Harvard School of Public Health study found that people who are generally hopeful were less likely to develop hypertension, diabetes, or respiratory tract infection than those who were less hopeful.
From this report you'll learn the following:
• Using the positive in your life
• Finding and using your inner character strengths
• Achieving the “flow” experience
• Putting mindfulness to use toward well being
• Developing gratitude
• Savoring pleasure
• Finding the meaningful live

Αυτοϋπνωση και πόνος

Συγγραφέας Δαλαμάγκα Μαρία

Οι δυνατότητες της αυτοϋπνωσης μπορούν να γίνουν ιδιαίτερα χρήσιμες στην διαχείριση του πόνου. Είναι δυνατόν να τροποποιήσεις την εμπειρία του πόνου.Το μόνο εμπόδιο είναι τα όρια της φαντασίας , αλλά όπως σίγουρα ξέρεις η φαντασία γνωρίζει ελάχιστα όρια.
Μερικές φορές μπορεί να βοηθήσει η βαθιά χαλάρωση, πριν δώσεις στον εαυτό σου τις υποβολές που χρειάζεσαι.΄Αλλες φορές , απλά άφησε τον εαυτό σου να ταξιδέψει και να γίνει ένα με αυτές τις υποβολές και έτσι μπορεί να οδηγηθείς σε μια trance κατάσταση , χωρίς βαθιά χαλάρωση.
Τι είναι trance ;
Trance δεν είναι μια μυστικιστική εμπειρία που μόνο οι εκπαιδευμένοι υπνωτιστές μπορούν να επάγουν. Είναι μέρος της καθημερινής μας ζωής.Αν ποτέ οδηγώντας ένα αυτοκίνητο , ξαφνικά ανακάλυψες ότι οδηγούσες για μίλια χωρίς να το συνειδητοποιήσεις , θα καταλάβεις για τι πρόκειται(όπως μπορεί να συμβεί και διαβάζοντας ένα καλό βιβλίο).Περιγράφεται συχνά σαν “ η απώλεια της αίσθησης του χρόνου”.Το μυστικό είναι να αποκτήσεις κάποια εμπειρία , έτσι ώστε να έχεις τον έλεγχο να ξέρεις τι να κάνεις όταν μπεις σε μια trance κατάσταση.Είναι δηλαδή μια ευκαιρία για να αποκτήσεις τον έλεγχο της φυσικής και συναισθηματικής εμπειρίας του πόνου.
Η αποτελεσματικότητα χρησιμοποιώντας αυτοϋπνωση , είναι θέμα εξάσκησης. Θα βοηθούσε να πειραματισθείς με διαφορετικές προσεγγίσεις και να βρεις αυτή που σου ταιριάζει καλύτερα και ποιά είναι η πιο χρήσιμη. Πριν ξεκινήσεις κάνε μια αναθεώρηση της εμπειρίας του πόνου.Υπάρχει κάποιος καλός λόγος , που θέλεις να παραμείνεις σε αυτή την κατάσταση; Σου προσφέρει κάτι, όπως προσοχή ή ξεκούραση; με αυτό τον τρόπο θα αποφασίσεις ότι θέλεις να κάνεις τη διαφορά. Όταν ξεκινήσεις για πρώτη φορά , θα ήταν καλό να γίνει σε μια χρονική στιγμή που ο πόνος δεν είναι τόσο άσχημος.Οταν γίνεις πιο οικείος με τις αυτοϋπνωτικές προσεγγίσεις , θα είναι πιο εύκολο να το χρησιμοποιήσεις, όταν ο πόνος είναι πιο έντονος.
Έχει αναφερθεί , ότι η διάρκεια της αναλγησίας αυξάνει μέρα με τη μέρα.Είναι χρήσιμο να σκέφτεσαι τη δυνατότητα ελάττωσης , παρά εξαφάνισης του πόνου. Έτσι αν φανταστείς μια σκάλα από το 1-10 , και αν ξεκινήσεις ταξινομώντας τον πόνο σου στο επίπεδο 7, τότε ο σκοπός σου θα είναι να τον ελαττώσεις στο 5 ή στο 4.Φτάνοντας σε αυτό το επίπεδο θα αισθανθείς πιο άνετα. Με το χρόνο θα βρεις τον εαυτό σου να ελαττώνει τα επίπεδα του πόνου στο 2 ή 3.Μπορεί ακόμη να δεις τον πόνο σου να αγγίζει το 0. Αυτό θα είναι θαυμάσιο. Και ακόμη και αν ελαττώσεις τον πόνο σου σε κάποιο επίπεδο, δες τη διαφορά ανάμεσα στα δυο επίπεδα πόνου και επιβράβευσε τον εαυτό σου για τον έλεγχο που έχεις επιτύχει.
Βασικές προσεγγίσεις- Τεχνικές διαχείρισης πόνου:
Τροποποιώντας τη φυσική εμπειρία
Σκέψου μερικούς τρόπους που μπορείς να αλλάξεις τη φυσική εμπειρία του πόνου , για παράδειγμα:
Φαντάσου ότι η προσβεβλημένη περιοχή του σώματος σου είναι κάτω από την επίδραση ενός ισχυρού αναλγητικού όπως Novocaine.
Σε μερικά είδη πονοκεφάλων , βοηθάει να φανταστείς τα χέρια σου να γίνονται ζεστά και βαριά(επανέλαβε στον εαυτό σου : τα χέρια μου γίνονται ζεστά και βαριά). Συνέχισε να αισθάνεσαι αυτή τη ζεστασιά στα πόδια σου και τα δάκτυλα σου (οι πονοκέφαλοι μπορεί να υποχωρήσουν , κατευθύνοντας την αιματική ροή μακριά από το κεφάλι και προς τα άκρα).
Φέρε στην μνήμη σου καταστάσεις που σου προκαλούν αναλγησία :
Σκέψου την αίσθηση πάγου στην προσβεβλημένη περιοχή ή από την άλλη πλευρά την αίσθηση ζεστασιάς.
Ενθυμήσου τα αναλγητικά αποτελέσματα ενός αναλγητικού.Φέρε στη μνήμη σου, όλες τις αισθήσεις , τι έβλεπες , τι άκουγες και τι αισθανόσουνα.
Τροποποιώντας την αντίληψη του πόνου:
Σκέψου μερικούς τρόπους , μέσα από τους οποίους θα δεις τον εαυτό σου να αντιλαμβάνεται τον πόνο με διαφορετικό τρόπο.Δες τον εαυτό σου σαν ένα τραυματισμένο μαραθωνοδρόμο , που είναι αποφασισμένος να συνεχίσει μέχρι τέλους.
Τροποποιώντας τις λέξεις αναφοράς:
Αν αλλάξει ο τρόπος που περιγράφεται η φυσική εμπειρία , θα αλλάξει και ο τρόπος που αντιλαμβανόμαστε τον πόνο.
Για παράδειγμα:
Αντί για τη λέξη “πόνος” μπορεί να χρησιμοποιήσουμε τον όρο “διαξιφιστική” αίσθηση ή αίσθηση “δόνησης”
Διαχωρισμός:
Δες τον πόνο σου σαν τρίτο – εξωτερικό άτομο. Μπορεί να αποφασίσεις να αναλύσεις την αίσθηση του πόνου και μετά να συγκρίνεις την προσβεβλημένη περιοχή με ένα άλλο μη επώδυνο σημείο (με αυτό τον τρόπο μπορεί να ξεκινήσεις να εστιάζεις την προσοχή σου σε μη επώδυνες περιοχές)
Απόσπαση προσοχής:
Μπορούμε να κρατήσουμε το μυαλό μας απασχολημένο σε άλλα πράγματα
Για παράδειγμα:
Φαντάσου ότι είσαι κάπου που είναι πολύ χαλαρωτικό για σένα( όπως μια παραλία ή ένας κήπος).Εστίασε έντονα την προσοχή σου σε αυτή την εμπειρία- δες όλα τα πράγματα που είδες. Όλους τους ήχους που άκουσες, μύρισε , γεύσου και δες όλα τα όμορφα συναισθήματα που είχες.Εστίασε σε ένα μέρος του σώματος σου που αισθάνεται άνετα.Ανέλυσε ακριβώς πως αισθάνεται αυτό το μέρος του σώματος σου. Παρατήρησε πόσο θερμό ή δροσερό αισθάνεται αυτό το μέρος του σώματος σου.Παρατήρησε τις αισθήσεις σου και πως αλλάζουν από λεπτό σε λεπτό. Αναλογίσου πως η καρδιά και το μυαλό σου , παίζουν κάποιο ρόλο στη λειτουργία του σώματος σου και στην αντίληψη του πόνου.
Οι τεχνικές που προαναφέρθηκαν είναι απλά η αρχή. Μόλις ανακαλύψεις πόσο ισχυρός σύμμαχος είναι το μυαλό σου στην τροποποίηση της εμπειρίας του πόνου, τότε θα ανοίξει η πύλη για τις προτεινόμενες υποβολές.
Έλεγχος πόνου
Πειραματίσου με το παρακάτω:
Σκάναρε το σώμα σου ... συγκέντρωσε όλους τους πόνους σε μια μπάλα ...ξεκίνα να τροποποιείς το μέγεθος της...δώσε της το περιθώριο να γίνει όσο μεγάλη μπορεί...τώρα κάνε την μικρότερη..παρατήρησε πόσο μικρή μπορείς να την κάνεις..είναι δυνατόν να πλησιάσει το μέγεθος μιας κουκίδας άμμου...μετακίνησε την σε μερικές κατευθύνσεις ...τώρα άφησε την να μετακινηθεί αργά έξω από το σώμα , κινούμενη όλο και πιο μακριά σε κάθε εκπνοή. Παρατήρησε πως αισθάνεσαι με κάθε εκπνοή, καθώς ο πόνος απομακρύνεται...δες την να εξαφανίζεται σε μακρινή απόσταση.
Δες τον εαυτό σου ξαπλωμένο δίπλα στα νερά μιας βαθυγάλαζης θάλασσας. Άσε τον εαυτό σου να γλιστρήσει στο δροσερό , απαλό νερό και να κολυμπά αργά. Αισθάνσου κάθε πόνο να φεύγει από το σώμα σου και να πέφτει στο βυθό της θάλασσας...Άσε τον εαυτό σου να κολυμπάει, μέχρι να αισθανθείς εντελώς χαλαρωμένος και άνετος ...έπειτα πλησίασε στην ακτή και βγες στην αμμουδιά.
Επικοινώνησε με τον πόνο σου:
Δες τον εαυτό σου σε ένα όμορφο, γαλήνιο τοπίο...Εντόπισε τον πόνο και ζήτησε του να έρθει , να επικοινωνήσει μαζί σου ...άφησε τον πόνο να πάρει μερικές μορφές σαν ένα μικρό πλάσμα με ένα φιλικό πρόσωπο...Άφησε το να πει τι το απασχολεί και άκουσε το με σεβασμό και με ένα ανοιχτό μυαλό..Δες τις θετικές προθέσεις του..Μόλις ανακαλύψεις το μάθημα που έχει έρθει να σου δώσει και να μοιραστεί μαζί σου, ευχαρίστησε το και πες του ότι έμαθες αρκετά..Παρατήρησε το πλάσμα να δίνει ένα γλυκό χαμόγελο και να φεύγει μακριά σου, ο στόχος του ολοκληρώθηκε και έτσι δεν χρειάζεται περαιτέρω να επικοινωνεί μαζί σου μέσω του πόνου.
Φαντάσου να κατεβαίνεις με ένα ανσασέρ το οποίο σε οδηγεί από την πλήρη εγρήγορση στο υποσυνείδητο σου ..φαντάσου την πόρτα του ανσασέρ να ανοίγει και βρες τον εαυτό σου σε ένα τεράστιο διάδρομο με πολλές πόρτες...φαντάσου να μετακίνησε στο διάδρομο και να βλέπεις πολλές πόρτες, κάθε μια φέρει σαν όνομα ένα μέρος του σώματος σου... Πήγαινε στην πόρτα στην πόρτα που έχει σαν όνομα , το μέρος του σώματος σου που είναι η πηγή του πόνου..Χτύπα την πόρτα και φαντάσου την πόρτα να ανοίγεται μπροστά σου..Φαντάσου ότι είσαι καλοδεχούμενος στο δωμάτιο και άφησε τον εαυτό σου ναν έχει μια συζήτηση με αυτό το μέρος του σώματος σου, άφησε το να σου πει ότι χρειάζεται από εσένα..Όταν τελειώσεις τη συνομιλία , ευχαρίστησε αυτό το μέρος σου, άφησε το δωμάτιο και επέστρεψε στο ανσασέρ...άφησε τον εαυτό σου να ανέβει επάνω , μέχρι να επιστρέψεις σε πλήρη εγρήγορση και πάλι.
Αναδρομή:
Με την αναδρομή πηγαίνεις πίσω στο χρόνο πριν την εμφάνιση του πόνου.Πάρε λίγο χρόνο για να αφήσεις τον εαυτό σου να χαλαρώσει, ίσως εστιάζοντας στην αναπνοή σου για λίγο. Πήγαινε πίσω το χρόνο εκεί που δεν υπήρχε πόνος.Για παράδειγμα αν έχεις αρθρίτιδα:
Θυμήσου το χρόνο πριν ξεκινήσει η αρθρίτιδα, όταν τα πόδια σου δεν ήταν επώδυνα..θυμήσου τις βόλτες που έκανες κοντά στο σπίτι ή σε διακοπές.Θυμήσου πόσο διασκεδαστικό ήταν να χορεύεις, να τρέχεις ή να κολυμπάς.Αφησε τον εαυτό σου να εισέλθει σε αυτές τις καλές αναμνήσεις , χρησιμοποιώνταςόλες τις αισθήσεις σου , για να δεις ,να ακούσεις και ζήσε την κάθε στιγμή..και παρατήρησε τι αίσθηση έχουν τα πόδια σου(μπορεί να τα θυμηθείς τόσο ανάλαφρα ,ζεστά ή δροσερά ή δυνατά ή χαλαρωμένα)
Για παράδειγμα:
“Μπορεί να ανακαλύψω ότι στην θύμηση αυτού του υπέροχου χρονικού διαστήματος , τα πόδια μου έχουν την αίσθηση της δροσιάς και είναι ανάλαφρα.Μπορεί να ανακαλύψω ότι αυτή η άνεση στα πόδια μου διαρκεί για ένα μικρό χρονικό διάστημα ή ίσως διαρκεί περισσότερο από ότι πίστευα”...Δες τη διαφορά σε μικρές αλλαγές στην ποιότητα του πόνου και ενθάρρυνε τον εαυτό σου να συνεχίσει.
Απώλεια της αίσθησης του χρόνου:
Αυτή μπορεί να είναι μια χρήσιμη τεχνική , αν υπάρχουν χρονικά διαστήματα που ο πόνος είναι περισσότερο έντονος και άλλες φορές που είναι ελάχιστος ή μηδαμινός.Οφείλεται στην ικανότητα μας , όταν αισθανόμαστε καλά , να χάνουμε την αίσθηση του χρόνου και να ανακαλύπτουμε ότι ο χρόνος έχει περάσει πιο γρήγορα, χωρίς να το συνειδητοποιήσουμε.
Χρησιμοποίησε αυτή την προσέγγιση, όταν αισθάνεσαι σχετικά άνετα και με λιγότερο πόνο.Αφησε τον εαυτό σου να χαλαρώσει βαθιά και ετοιμάσου για αυτοϋπνωση. Άφησε τον εαυτό σου να εστιάσει σε αυτή τη στιγμή που αισθάνεσαι άνετα..Σκέψου κάποιες στιγμές που θα σου δώσουν την ιδέα της επιμήκυνσης του χρόνου, όπως οι πιο ευχάριστες διακοπές που είχες ή το ευχάριστο συναίσθημα που είχες όταν παρακολουθούσες την αγαπημένη σου ταινία.Μπορει να είναι διασκεδαστικό να δεις πόσο μπορεί να διαρκέσει αυτό το συναίσθημα.
Μια άλλη προσέγγιση είναι να φανταστείς ένα ταξίδι- “Μπορώ να φανταστώ ότι κάνω ένα μεγάλο ταξίδι , περνώντας από πολλές πόλεις. Και κάθε πόλη έχει ένα σταθμό που μπορώ να σταματήσω και να ξεκουραστώ.Αισθάνομαι άνεση και χαλάρωση στον πρώτο σταθμό τώρα.Ισως αυτό το συναίσθημα της άνεσης και το επίπεδο της ανακούφισης θα διαρκέσει μέχρι τον επόμενο σταθμό.Και κοιτώντας το δρόμο, σχεδόν βλέπω τα φώτα της επόμενης πόλης και του επόμενου σταθμού .Μπορεί να ανακαλύψω ότι η απόσταση για την επόμενη πόλη είναι μικρότερη από ότι φανταζόμουνα και μπορεί να μείνω έκπληκτη όταν παρατηρήσω ότι ακόμη αισθάνομαι άνετα, όπως στον πρώτο σταθμό. Μπορεί να εντοπίσω το σταθμό να πλησιάζει σε όλο και μικρότερη απόσταση”. Άσε το ταξίδι να διαρκέσει όσο επιθυμείς και συμπλήρωσε το κενό μεταξύ των πόλεων με εικόνες που μπορεί να δεις στην πορεία του δρόμου.
Η αυτοϋπνωση είναι μια ευκαιρία να χρησιμοποιήσεις το δημιουργικό σου μυαλό σε όλο του το μεγαλείο, στην υπηρεσία του καλού φυσικού και συναισθηματικού σου γίγνεσθαι.

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MUSCLE PAIN

According to recent research published in the journal Pain, "Interleukin-6 (IL-6) is an inflammatory cytokine known to modulate muscle pain. However, the mechanisms underlying this effect still remain unclear."

"Here we show that the injection of IL-6 into mice gastrocnemius muscle evoked a time-and dose-dependent mechanical hyperalgesia. This effect is in part dependent on the presence of gp130 expression in inflammatory cells in the gastrocnemius muscle as well as in DRG neurons. We also demonstrated an increased inflammatory cell recruitment and cytokines levels, namely TNF-alpha, IL-1 beta and KC. TNFR1(-/-) mice or mice pre-treated with the selective CXCR2 antagonist, SB225002, with the anti-macrophage, anti-TNF-alpha or anti-KC antibodies or with IL-1 receptor antagonist (IL-1RA) showed decreased IL-6-mediated mechanical hyperalgesia. Furthermore, systemic pre-treatment with the classically used drugs indomethacin, celecoxib, guanetidine, morphine, thalidomide or dexamethasone, also prevented IL-6-induced muscle pain. Likewise, local pre-treatment with inhibitors of phospholipase A2 (PACOCF3), phospholipase C (U73122), protein kinase C (GF109203X), protein kinase A (KT-5720) or with phosphatidylinositol 3-kinase (AS605204) also consistently diminished IL-6-induced muscle hyperalgesia. The intramuscular injection of the selective inhibitors of p38 MAPK (SB203580), ERK (PD98059) or JNK (SP60015) also prevented IL-6-mediated muscular pain. Simultaneous flow cytometry measurements revealed that ERK, p38 MAPK and JNK were phosphorylated as early as 5 min after IL-6 injection. These findings provided new evidence indicating that IL-6 exerts a relevant role in the development and maintenance of muscular hyperalgesia," wrote M.N. Manjavachi and colleagues, Federal University .

The researchers concluded: "The IL-6-mediated muscular pain response involves resident cell activation, polymorphonuclear cell infiltration, cytokine production, prostanoids and sympathomimetic amines release and the activation of intracellular pathways, especially MAPKs."

Manjavachi and colleagues published their study in Pain (Mechanisms involved in IL-6-induced muscular mechanical hyperalgesia in mice. Pain, 2010;151(2):345-355).

Music

Most of us have already heard the loose rumor that "classical music is good for your brain", whether as brain-booster while working or as something that mothers should be doing for their developing children or even "sound as audio therapy" unto itself. For many, it may feel intuitive that listening to complex classical music pieces must somehow be better for one's brain than listening to, say, a simplistic three-chord rock anthem or a Rap track featuring a single looping drum beat with repetitive vocal (or many other genres of current pop/rock/rap music). 

Or does that truly depend on the song in question, or one's world view, or one's attention to complex subtle nuances that may lie just below the surface of a seemingly trite piece of Pop?

The truth is that the potential for brain-boosting benefits from listening to music (or sound content of any type, for that matter) is a largely unstudied area, ripe for much deeper research spanning far more genres of "organized sound" (music) than certainly exist to date. The trouble is that this kind of research, like most other brain-related research, is extremely difficult to derive clear indications from... clear results and empirical data, given the massive number of variables that enter into the mix when trying to test how music truly impacts real-world human subjects. 

The good news is that there already is some good research that suggests impressive, exciting news as to how music can enhance brain function, and if one takes a step back to extrapolate these research results and make an intuitive personal judgment regarding how music may help, it's a no-brainer (sic) to consider giving it a try. And why not: no side effects or contraindications with music listening, unlike supplements and medications and some foods!

The research: music with exercise? In one research study, clinical psychologist Charles Emery of Ohio State University studied the effect of music on people who listened (or did not listen) during regular physical exercise. Emery says, "I've always thought that music had many benefits for people, and increasingly people use music when they exercise, so it seemed like a logical next step in terms of a research project". So along with Evana Hsiao and Scott Hill of Ohio State, and David Frid of Pfizer, Inc., Emery put his theory to the test, with the help of 33 men and women in the final weeks of a cardiac rehabilitation program. Each of the participants were tested for mental performance after exercising without music, and exercising with music.

The results were astonishing: on average, the participants performed more than twice as well on a verbal fluency test after listening to music while exercising than they did after exercising without the music. Wow!

The music selected? Vivaldi's "The Four Seasons".

"When there was no music, there was no change," Emery says.

Emery chose Vivaldi's "The Four Seasons" for the project because prior research by other scientists with that particular piece indicated that it helped patients with lung disease perform better mentally. Emery suspects, however, that similar benefits could be gained by listening to ALL kinds of music, not just classical. It is theorized that the passionate, upbeat rhythms of "The Four Seasons" may stimulate mental performance because it is complex, thus forcing the brain to organize neural transmissions. 

But other selections might work better for some people. "I don't think there is anything specific to Vivaldi or even classical music that would necessarily trigger enhanced brain function," Emery says. 

But he is confident that music makes a difference, whether it is jazz, hip hop, or classical. And while his research was centered on cardiac patients, because they often suffer mental decline as a result of their illness, Emery thinks it works for everybody, not just those who are sick.

Several other research studies have illustrated how listening to music is a more complex endeavor than it seems on the surface: the human brain has to sort out tones, timing, and sequencing of various sounds, in order to comprehend music. It is believed that the frontal lobe of the brain is stimulated and activated by listening to music, as it is the part of the brain that is associated with higher mental functions such as thinking abstract thoughts, or planning for the future.

Vivaldi or Mozart, but not Glass? Psychologist Frances Rauscher, now at the University of Wisconsin at Oshkosh, and her colleagues made waves with the discovery that listening to Mozart improve d people's mathematical and spatial reasoning. Even rats ran mazes faster and more accurately after hearing Mozart than after white noise or music by the minimalist composer Philip Glass. Sorry, Glass fans. Rauscher reported that, for rats at least, a Mozart piano sonata seems to stimulate activity in three genes involved in nerve-cell signalling in the brain.

But don't just listen, join in: it's one thing to listen passively to music in order to derive brain benefits. But even more brain-engaging, and even IQ-boosting, is playing or writing music, including taking music lessons. 

In fact, six-year-old children who were given music lessons, as opposed to drama lessons or no extra instruction, got a 2 to 3-point boost in IQ scores compared with the others. Similarly, Rauscher found that after two years of music lessons, pre-school children scored better on spatial reasoning tests than those who took computer lessons.

Although not yet tested with adults, there is little reason why similar benefits would not also apply to adults, including the elderly, which is why we here at BrainReady (and most other cognitive health experts) routinely recommend learning to play a new instrument and learning to read and write music (visually or even intuitively through experimentation) as wonderful mental health and brain fitness steps that adults of all ages should strongly consider.

Learning a new instrument, learning to read or write music -- these activities exercise a wide range of mental skills, with their requirement for delicate and precise finger movements, listening for pitch and rhythm, learning harmony and harmonic complexity, all combined with an emotional dimension, as well as memory. And this makes sense intuitively: if you're someone who has never played an instrument or learned to read or write music, and then one day you start on the long process of learning, what do you think is happening to your brain? Would your brain be different, better, more capable, one year after consistently working at it and becoming a capable musician? 

The relaxation factor: then there's the obvious other area of benefit from listening to (or playing) music...relaxation and enjoyment. When you listen to or engage in music that makes you feel happy, relaxed, deeply engaged, contemplative, you're reaping some of the same deep relaxation effects that such activities as restful sleep, a warm bath, a wonderful meal, have on your overall stress level and physiological state. Simply put, it's relaxing, and that reduces stress, and stress is one of the biggest health hazards to brain & body alike. 

Now, not all music produces such a state of calm relaxation, particularly as everyone's musical tastes are somewhat unique. Some may find Speed Metal or bombastic Hip-Hop deeply calm-inducing and mentally therapeutic while becoming filled with rage at the mere thought of a Celine Dion or Barbara Streisand vocal. Others may find the inverse. But there may well be something to listening to classical orchestral music, or music that is equally complex (large number of instruments, fairly complex harmonic and lyrical structure, emphasis on notes and melodies rather than repetitive drum beats or simplistic repeating motifs as found in most Pop music). So if you're going to select your "brain health music", it may be wise to include some Mozart, Vivaldi, Bethoven, Bruckner, Stravinsky and other greats.