Saturday, May 28, 2011

Carl Allen Hammerschlag

"I am a Yale-trained, community psychiatrist whose professional life took an interesting departure from ordinary clinical practice when I went to work with American Indians instead of going to Vietnam. 

I joined the Indian Health Service for my 2-year military obligation, and it turned into a 20-year commitment, most of it as Chief of Psychiatry at the Phoenix Indian Medical Center. 

This experience moved me from doctor to healer -- a transformational journey in which my scientific healing repertoire was expanded to include more mystical explanations for how people get sick and how they get well. 

In Indian country I learned how to use the power of language, stories and beliefs, incorporating them into my psychotherapy.  I saw how rituals, ceremonies, prayer, meditation, fasting, drumming, natural medicines, and hands-on healing could open channels into the unconscious mind to promote insight and change behavior. 

Over the last 40 years, I have come to embrace shamanic healing practices.  A shamanic healer understands that everything that exists in life has an energy that can be a force for healing

Every scientific discipline and every religious group uses its own words to describe that energy.  Scientists explain that force in physical terms such as quanta, strong and weak, or in molecular, biological, and genetic terms.  Mystics explain the force in spiritual terms:  unknowable, unfathomable, or ineffable.   

The critical issue to remember is that both scientific practitioner and shamans find a way to develop a relationship with that force that allows them to harness its energy and promote healing." 

Hammershlag, C. (2009). The Huichol Offering:  A Shamanic Healing Journey. J Relig Health, 48, 246-258.

The Flash Mob that Makes Me Cry :)

I cry freely when the spirit moves me and the spirit is alive and well in this YouTube video of a flash mob of middle school students, each with their favorite book, dancing and singing in unison, about the utter joy of reading!! (only 2 exclamation points is me showing restraint).

The collective power of the spirit of community knocks me over. Working at schools, I can attest to the powerful individual and collective energy of students.  Being a nerd and avid reader, I can bear witness to the power of reading to transform and open up imagination, creativity and ideating.  As a lay dancer, I can testify to the power of movement and music to express self and joy and heal.

Here it is:  Gotta Keep Reading Middle School Flash Mob, enjoy!

If you work with young people or at a school, or if you work with older folks anywhere for that matter, here is a YouTube video with  Music and Lyrics for "Gotta Keep Reading".  Feel free to use it to start your own flash mob of love.

In the paraphrased words of will.i.am, flash mobs show that deep down we all really want to collaborate and work together.  "Shamanistic healing practices involve rituals that enhance social integration, strengthen group identity, and promote interpersonal and social bonding at physiological and psychosocial levels. . . these shamanic activities affect opioid-attachment interactions, utilizing the innate drive for affiliation to evoke opioid release. (Winkelman, 2001, p. 343)"  The spirit of shamanism lives in us. Let's wake the spirits for good health and community and reading! Oh, what a feeling, baby! ooh oo oo.

Winkelman, M. (2001). Alternative and traditional medicine approaches for substance abuse programs: a shamanic perspective. International Journal of Drug Policy, 12, 337-351.

Learning to Edit

I gave my adviser a draft of my publishable paper.  He is a rock star when it comes to writing, having been the editor of a top social work journal.  He said I could cut out 60% of the words in my "reasonably good" draft.

I gave Dr. Glik, an international expert on social media and health communications, a copy of the "statement of problem" from my dissertation proposal.  She gave me thoughtful written feedback and when I met with her she said, "leave them in suspense."

In an effort to scale back, I am taking a full leave of absence from work to dedicate my time and (limited psychic) energy to writing.  Just in time.  Stretching myself thin by juggling work, school and family takes its toll.  Lesson learned:  Never experiment with cutting corners in time by cutting your time with friends and extended family.  It is a recipe for disaster (duh). 

I am learning to edit.  Less is more.

Monday, May 23, 2011

Family Violence

Title:  Silent victims: children exposed to family violence

Author:  Kolar, Kathryn R; Davey, Debrynda

Source:  Journal of School Nursing, vol. 23, no. 2, pp. 86-91, April 2007

Abstract:
Annually an estimated 3 million or more children are exposed to acts of domestic violence between adults in their homes.

These children are at risk for abuse themselves as well as other immediate and long-term problems, especially if they have been exposed to repeated episodes of domestic violence. 

Multiple behavioral manifestations, including anxiety, depression, and PTSD, may be associated with violence exposure, and it is imperative that school nurses recognize these.

All children should be screened for domestic violence exposure at regular intervals, and those who are at risk should have a more thorough health assessment. Planning for the safety of the child, nonoffending caregiver, and siblings and the school nurse involved in the situation is of utmost importance.

Cannabis Findings

Title: Stress-related factors in cannabis use and misuse: implications for prevention and treatment

Author:  Hyman, Scott M; Sinha, Rajita

Source:  Journal of Substance Abuse Treatment, vol. 36, no. 4, pp. 400-413, 2009

Abstract:

We examined the role of stress as a risk factor and motivation for cannabis use/misuse. A systematic review of studies gathered from PsycINFO and MEDLINE databases was conducted. Findings suggest that cannabis is commonly used as a stress-coping strategy. Negative life events, trauma, and maladaptive coping were all related to consumption.

Cannabis use for stress-coping purposes was most evident when examining chronic as compared with experimental use. Although many individuals may be able to use cannabis without consequences, there appears to be a subset of individuals who experience greater life stress and who may be more likely to use for stress-coping purposes. These individuals may be at greatest risk for addiction. Chronic use may potentiate stress-related motivation to use/abuse cannabis and is associated with decision-making deficits and alterations in brain-stress pathways that may exacerbate compulsive drug seeking and sensitize individuals to stress-related drug use. Overall, stress-coping interventions and harm reduction focused on reducing the amount ingested may facilitate prevention and recovery efforts.

What We Know about Trauma Treatment Outcomes for Children

Title:  A meta-analytic review of the treatment outcome literature for traumatized children and adolescents [dissertation]

Author:  Puttre, Jessica J

Source:  St. John's University (New York), 2010. 120 pp.

Abstract:

More than two thirds of children in the general population report exposure to at least one traumatic event by the age of 16.

In addition to high prevalence rates of PTSD, the children exposed to trauma have almost double the rates of developing psychiatric disorders such as affective and anxiety disorders than those not exposed.

Evidence-based psychological interventions are clearly needed to address these psychiatric difficulties; however, the treatment outcome literature for traumatized children is limited as compared to the breadth published for adults. Furthermore, research disseminating the treatment outcome literature is even sparser as only one meta-analysis has examined all trauma types and reactions in traumatized children.

Results from this meta-analysis revealed that Cognitive Behavioral Therapy resulted in statistically significant treatment effects for Post Traumatic Stress Symptoms (PTSS) (d = .50). Although, this research filled a gap in the treatment outcome literature for traumatized children, the strict article inclusion criteria left many studies out of the analysis. The present research attempts to build upon the research of Silverman et al. by widening the inclusion criteria and more than tripling the amount of research studies included in the analysis. In fact, this present meta-analysis identified 67 usable studies (61 published journal articles and 6 dissertations).

The most commonly utilized form of treatment was general CBT (20.9%), followed by TF-CBT (16.4%). In general, CBT interventions were more commonly used than non-CBT interventions (respectively, 58.2%, 41.8%). These interventions were more often conducted in a group format (40.3%); however, individual therapy was also a highly utilized form of treatment delivery (34.3%).

A large overall trauma within group unweighted effect size was found (M = 0.80; SD = 0.68) which indicates that after receiving treatment for trauma, children and adolescents demonstrated positive changes on the outcome measures. Effect sizes were also examined by treatment type, construct used to measure change, service delivery method, duration of treatment, and setting of treatment. This was the first meta-analysis of trauma with children and adolescents to examine effect size as a function of who was reporting change, and the largest effect sizes were found for ratings by structured interview, followed by clinician-report, self-report, parent report, and teacher report, with structured interview being the only significantly different rating. A medium to large positive effect size was found for the overall comparison of trauma treatment to control groups. A small to medium positive effect size was found for the overall comparison of TF-CBT to alternative groups. Limitations and implications for school psychologists are discussed.

Adapting CBITS for American Indian Youth

Title:  Adaptation and implementation of cognitive behavioral intervention for trauma in schools with American Indian youth

Author: Goodkind, Jessica R; LaNoue, Marianna D; Milford, Jaime L

Source: Journal of Clinical Child and Adolescent Psychology, vol. 39, no. 6, pp. 858-872, November 2010

Abstract:
American Indian adolescents experience higher rates of suicide and psychological distress than the overall U.S. adolescent population, and research suggests that these disparities are related to higher rates of violence and trauma exposure. Despite elevated risk, there is limited empirical information to guide culturally appropriate treatment of trauma and related symptoms.

We report a pilot study of an adaptation to the Cognitive Behavioral Intervention for Trauma in Schools in a sample of 24 American Indian adolescents. Participants experienced significant decreases in anxiety and PTSD symptoms, and avoidant coping strategies, as well as a marginally significant decrease in depression symptoms. Improvements in anxiety and depression were maintained 6 months postintervention; improvements in PTSD and avoidant coping strategies were not.

Emotions, Substance Abuse, Self-Injury & Child Abuse

Title:  Associations between sexual abuse and family conflict/violence, self-injurious behavior, and substance use: the mediating role of depressed mood and anger

Author:  Asgeirsdottir, Bryndis Bjork; Sigfusdottir, Inga Dora; Gudjonsson, Gisli H; Sigurdsson, Jon Fridrik

Source:  Child Abuse and Neglect, vol. 35, no. 3, pp. 210-219, March 2011

Abstract:

OBJECTIVE: To examine whether depressed mood and anger mediate the effects of sexual abuse and family conflict/violence on self-injurious behavior and substance use.

METHODS: A cross-sectional national survey was conducted including 9,085 16-19 year old students attending all high schools in Iceland in 2004. Participants reported frequency of sexual abuse, family conflict/violence, self-injurious behavior, substance use, depressed mood, and anger.

RESULTS: Sexual abuse and family conflict/violence had direct effects on self-injurious behavior and substance use among both genders, when controlling for age, family structure, parental education, anger, and depressed mood. More importantly, the indirect effects of sexual abuse and family conflict/violence on self-injurious behavior among both males and females were twice as strong through depressed mood as through anger, while the indirect effects of sexual abuse and family conflict/violence on substance use were only significant through anger.

CONCLUSIONS: These results indicate that in cases of sexual abuse and family conflict/violence, substance use is similar to externalizing behavior, where anger seems to be a key mediating variable, opposed to internalizing behavior such as self-injurious behavior, where depressed mood is a more critical mediator.

PRACTICE IMPLICATIONS: Practical implications highlight the importance of focusing on a range of emotions, including depressed mood and anger, when working with stressed adolescents in prevention and treatment programs for self-injurious behavior and substance use.

School-Based Intervention for PTSD

Title:  School-based intervention programs for PTSD symptoms: a review and meta-analysis

Author:  Rolfsnes, Erika S; Idsoe, Thormod

Source: Journal of Traumatic Stress, vol. 24, no. 2, pp. 155-165, April 2011

Abstract:
This is a review and meta-analysis of school-based intervention programs targeted at reducing symptoms of PTSD. 19 studies conducted in 9 different countries satisfied the inclusionary criteria. The studies dealt with various kinds of type I and type II trauma exposure. 16 studies used cognitive–behavioral therapy methods; the others used play/art, eye movement desensitization and reprocessing, and mind-body techniques. The overall effect size for the 19 studies was d = 0.68 (SD = 0.41), indicating a medium-large effect in relation to reducing symptoms of PTSD. The authors' findings suggest that intervention provided within the school setting can be effective in helping children and adolescents following traumatic events.

Pediatric PTSD & Mind-Body Research Gap

Title:  Psychophysiological characteristics of PTSD in children and adolescents: a review of the literature

Author:  Kirsch, Veronica; Wilhelm, Frank H; Goldbeck, Lutz

Source:  Journal of Traumatic Stress, vol. 24, no. 2, pp. 146-154, April 2011

Abstract:
This review summarizes studies investigating psychophysiological alterations associated with pediatric PTSD.

The authors conducted a computer-based search in the databases PsycINFO, PSYNDEXplus, and Medline. Additional studies were retrieved using a pyramid scheme. The literature search identified 29 articles.

Most studies measured alterations shortly after exposure. Differences from controls emerged mainly in the sympathoadrenal system and the hypothalamic–pituitary–adrenal axis. Elevated acute heart rate immediately after traumatization was associated with increased risk for PTSD.

The literature on psychophysiological characteristics of pediatric PTSD is relatively small and diverse. Nevertheless, findings indicate exaggerated baseline activation across various measures. Studies examining the course and reversibility of psychophysiological alterations are lacking.

Preventing Children's PTSD School-Wide

Title:  Preventing children's posttraumatic stress after disaster with teacher-based intervention: a controlled study

Author: Wolmer, Leo; Hamiel, Daniel; Laor, Nathaniel

Source:  Journal of the American Academy of Child and Adolescent Psychiatry, vol. 50, no. 4, pp. 340-348, April 2011

Abstract:

OBJECTIVE: The psychological outcomes that the exposure to mass trauma has on children have been amply documented in the past decades. The objective of this study is to describe the effects of a universal, teacher-based preventive intervention implemented with Israeli students before the rocket attacks that occurred during Operation Cast Lead, compared with a nonintervention but exposed control
group.

METHOD: The study sample consisted of 1,488 students studying in fourth and fifth grades in a city in southern Israel who were exposed to continuous rocket attacks during Operation Cast Lead. The intervention group included about half (53.5%) of the children who studied in six schools where the teacher-led intervention was implemented 3 months before the traumatic exposure. The control group
(46.5% of the sample) included six schools matched by exposure in which the preventive intervention was not implemented. Children filled out the UCLA-PTSD Reaction Index and the Stress/Mood Scale 3 months after the end of the rocket attacks.

RESULTS: The intervention group displayed significantly lower symptoms of posttrauma and stress/mood than the control group (p < .001). Control children had 57% more detected cases of PTSD than participant children. This difference was significantly more pronounced among boys (10.2% versus 4.4%) and less among girls (12.5% versus 10.1%).

CONCLUSIONS: The teacher-based, resilience-focused intervention is a universal, cost-effective approach to enhance the preparedness of communities of children to mass trauma and to prevent the development of PTSD after exposure.

After Trauma, Supporting Parents May Support Teens

Title:  Effects of parents' experiential avoidance and PTSD on adolescent disaster-related posttraumatic stress symptomatology

Author:  Polusny, Melissa Anderson; Ries, Barry J; Meis, Laura A; DeGarmo, David S; McCormick-Deaton, Catherine M; Thuras, Paul; Erbes, Christopher R

Source: Journal of Family Psychology, vol. 25, no. 2, pp. 220-229, April 2011

Abstract:
Despite the importance of family context to adolescents' reactions following disaster, little research has examined the role of parents' functioning on adolescents' disaster-related PTSD symptoms.

Using data from 288 adolescents (ages 12 to 19 years) and 288 parents exposed to a series of severe tornadoes in a rural Midwestern community, this study tested a conceptual model of the interrelationships between individual and parental risk factors on adolescents' disaster-related PTSD symptoms using structural equation modeling.

Results showed that the psychological process of experiential avoidance mediated the relationship between family disaster exposure and PTSD for both adolescents and their parents.

Parents' PTSD symptoms independently predicted adolescents' PTSD symptoms. Further, parents' post-disaster functioning amplified the effects of adolescent experiential avoidance on adolescents' disaster-related PTSD symptoms.

Findings highlight the importance of family context in understanding adolescents' post-disaster reactions. Clinical implications are discussed.

Building the Capacity to Bounce Back

Title: Promoting stress resistance in war-exposed children [editorial]

Author:  Asarnow, Joan Rosenbaum

Affiliation: Department of Psychiatry, University of California, Los Angeles CA, USA

Source:  Journal of the American Academy of Child and Adolescent Psychiatry, vol. 50, no. 4, pp. 320-322, April 2011

Abstract:   
The question of how to best enhance stress resistance and resilience in war- and trauma-exposed communities urgently needs data to inform public health and clinical programs.

Although some individuals and communities appear resilient and recover rapidly after exposure to war/traumatic experiences, others develop multiple secondary adversities and persistent mental health and functioning problems.

A report by Wolmer and colleagues focuses on children's reactions after a 3-week armed conflict in Israel and the Gaza Strip during which the civilian population was exposed to rocket and mortar attacks, extensive time in shelters, and continuing threats to safety and survival. The report describes the effects of a school-based stress-inoculation training (SIT) program designed to enhance stress resistance and resilience in fourth- and fifth-grade Israeli school children and implemented before the 3-week armed conflict. The preventive SIT intervention was integrated within the school curriculum and delivered by teachers.

Three months after the conflct, children from the six schools implementing the intervention compared with children from six other schools reported significantly lower levels of PTSD symptoms and lower scores on a scale assessing mood, anxiety, and stress problems.

Sunday, May 22, 2011

Temper Tantrum with Myself

Every assignment requires focused attention and effort.  But not all assignments are created equal.

I have just finished laboring over a statistical analysis and write up.  Not exceptionally difficult, but requiring focused attention and effort.  It is hard for me to invest time, attention and effort when I am not interested or passionate about the details of the assignment.  It takes herculean efforts to wrestle with myself and drag myself to the page, especially when it is difficult and I am stumped.

I thought this assignment was going to kill me -- really.  Panic set in on Friday.  I made a few phone calls - first, to a brilliant classmate and then a tutor whose number I got from a flyer I picked up in Stats class.  I needed some insurance if things got out of control.  I had started on the first question of the assignment and was already overwhelmed - vacillating between feeling confident and totally inept.  I tried telling myself affirming stuff like, It will get done. It always gets done. You are not the best or the worst student at UCLA, but someone let you in and you belong here. You have completed difficult assignments in the past, and so on.

I worked on the assignment until late into the night on Friday.  I went to Disneyland to celebrate my daughter's birthday on Saturday.  I started working on it as soon as I woke up on Sunday.  I took lots of breaks (running away from the discipline of focused energy) but kept coming back to the page until it got done.  One break included watching an Oprah episode in which she brings back her favorite guest of all time, a woman from a small village in Africa who was not allowed to go to school but achieved her dream of studying in America, despite all odds, and earned a BA, MA and PhD.  That brought me back to the page, feeling guilty even for all my whining.

At times, I cursed my stats professor, despite the fact that he is a kind and smart man.  When I thought I was going to die from the torture of this assignment, I blamed him for my untimely demise.  Now I see where my daughter gets her dramatics.  I will remember this the next time I want to tell her not to be so dramatic.  I celebrated the completion of the assignment with my daughter - this included tickling, a happy dance and baking a red velvet cake in the shape of a cupcake (I let her pick the fun activity).

Now I am working on my next assignment - a paper on the physiological mechanisms underlying yoga as a complementary treatment for asthma and other health problems.  My population of interest is low-income ethnic minority urban youth and their families.  They experience many health disparities and rates of health problems higher than the general population. 

Sitting in front of a stack of journal articles composing both a paper and presentation, I feel like I am back, baby.  The energy is flowing again.  It is easier to focus. 

What are you struggling to get done?  What helps you to get past your own internal temper tantrum? 
What brings you joy?  Where is your passion?  How can you structure your day and life around doing more of this or more often?

Relationship between Attachment Security & Child Obesity

Attachment Security and Obesity in US Preschool-Aged Children
Sarah E. Anderson, PhD; Robert C. Whitaker, MD, MPH

ABSTRACT

Objective: To estimate the association between attachment security in children aged 24 months and their risk for obesity at 41⁄2 years of age. Insecure attachment is associated with unhealthy physiologic and behavioral responses to stress, which could lead to development of obesity.

Design: Cohort study.

Setting: National sample of US children born in 2001.

Participants: Children and mothers participating in the 2003 and 2005-2006 waves of the Early Childhood Longitudinal Study, Birth Cohort, conducted by the National Center for Education Statistics. Our analytic sample included 6650 children (76.0% of children assessed in both waves).

Main Exposure: Attachment security at 24 months was assessed by trained interviewers during observation in the child’s home. Insecure attachment was defined as lowest quartile of attachment security, based on the security score from the Toddler Attachment Sort–45 Item.

Outcome Measure: Obesity at 41⁄2 years of age (sex-specific body mass index >/= 95th percentile for age).

Results: The prevalence of obesity was 23.1% in children with insecure attachment and 16.6% in those with secure attachment. For children with insecure attachment, the odds of obesity were 1.30 (95% confidence interval, 1.05-1.62) times higher than for children with secure attachment after controlling for the quality of mother-child interaction during play, parenting practices related to obesity, maternal body mass index, and sociodemographic characteristics.

Conclusions: Insecure attachment in early childhood may be a risk factor for obesity. Interventions to increase children’s attachment security should examine the effects on children’s weight.

Arch Pediatr Adolesc Med. 2011;165(3):235-242

Friday, May 20, 2011

NKISI

The Nkisi (pronounced in-kee-see) is a power figure of the Yombe peoples, Democratic Republic of the Congo (18th-19th century).  I met the Nkisi in the Fowler Museum during a class visit recently.  The anthropology graduate students gave us  a tour and introduced us to various healing artifacts from all over the world displayed in their permanent collection.  The nails in this Nkisi were nailed by community spiritual practitioners to wake the spirits so that community members could make their requests.  The strips of cloth hanging from the Nkisi's neck represent requests granted.  The Nkisi was probably displayed publicly and served as a reminder of the protection and power accessible to the community.  

This ritual from worlds away reminds me of growing up in a Spanish-speaking Pentecostal Christian church.  Every Tuesday, Friday and twice on Sundays, part of the church service included spontaneous prayer requests (peticiones) and testimonials about prayers answered (testimonios) from church members, interspersed with singing, clapping and playing the tambourine (to waken our spirit?). Where do we put it now?  Where do we take our requests?  How do we communicate our gratitude privately and publicly?  What symbols are meaningful to us now?

Typology of Anger and Health Effects

From my notes on a lecture by Dr. Hector Myers, in PSYCH 292 Biobehavioral Mechanisms of Stress and Disease:
"Anger is an adaptive response to provocation."
Anger is not evil, bad, wrong or the enemy!  As Rage Against The Machine so eloquently put it in a song, "Anger is a gift."

A mentor and recently retired Principal, used to say that what inspired him to do the work he did (school and community leader) was his anger.

Speaking of anger, I am also reminded of a 4th grade girl I was working with several years ago.  I told her that she had a right to her thoughts and feelings - that all feelings were normal and natural - that it was okay to feel angry.  The following week, she came to session stating that her aunt had told her that it was not okay to be angry.  We often confuse the feeling for the behavior - or vice versa. Feeling angry doesn't mean you have to do something that hurts yourself or others.  There is a difference between feelings and behaviors, although sometimes they are linked with lightning fast speed so we don't see their difference.  Slowing down the time between feeling and action - by reflecting on the thought that triggered the feeling in the first place (feelings do not bubble up out of nowhere) - gives us a chance to choose how we want to act, respond or behave.  In this way, we become the drivers of our thoughts, subsequent emotions and ultimately our behavior - responsible and powerful over our own lives.  Simple, but not easy.  Hard sometimes, but not impossible.  Like most things that are important to us, it takes intention and practice to hone the skill, the hope lies in the possibility.

I am also reminded of a 5th grade boy who was grieving the death of his father and teenage brother.  Initially engaged in counseling sessions, he soon reverted back to a cynical and defensive posture (which his teacher had been concerned about and one of the reasons she made the referral for counseling).  He would show up to counseling but refused to talk.  After a session of no talking (30 minutes long) and another where he complained of being "bored,"  I said I could understand how he might be bored if he refused to talk to me.  I decided that verbal sparring would get me nowhere with this smart young man.  So I sat silently again and prayed to God for some help - God, please help me!  What do I do with this young man?  How do I help him?  What do I say?  After my own anxiety, insecurity and feelings of incompetence subsided, the thought came to me and I said to him, this time with warmth and understanding instead of impatience - Oh, I get it, you're angry, of course, you're angry, you get to be angry, I'm not going to take that away from you, it makes sense to be angry, I would be angry too.  As I softened, so did he, his shoulders came down and he let down his guard.  He cried.  It's okay to cry, you are in a safe place, you can cry here, it's good to cry.

It also helps to know there are different types of anger with differential effects on our heart health.
"There are different types of anger expression observed.

'Anger-in' contributes to heart disease risk (hypertension) due to sustained physiological arousal prolonged by ruminating (going over negative or worry thoughts repeatedly).

There are two sub-types of 'Anger-out' expression:
1) Anger is expressed after a period of calm and after giving the provocation or situation some thought.  Put another way, you experience anger as a spike and then recover. 
2) Anger-reactive expression is cardiopathogenic (a fancy word which means 'risk factor for heart disease.' I would have just said that but I am a bit enamored with this new word at the moment).  Anger-reactive expression is characterized by a short temper and fuse, constant overreacting to everything - repeated spikes in which length of recovery is not ideal."
At lunch with another mentor, we talked about the challenge of managing emotions, whether it be passion or anger.  In a therapy session with a high school client, we talked about managing emotions in general.  No matter how old you are or what your station, it seems to be part of the human condition and an important part of our journey to struggle and become more skillful with managing our strong emotions. Cheers to healthy anger expression for good health!

Wednesday, May 18, 2011

Depression, Anxiety & Heart Disease

"Depression and anxiety predict coronary heart disease (CHD) morbidity and mortality, even after traditional CHD risk factors, such as serum cholesterol, blood pressure, and smoking, are controlled . . . In addition to affective dispositions, acute outbursts of anger, fear, or sadness and stressful events are also linked to the risk of heart attack."
Anger, Anxiety and Depression as Risk Factors for Cardiovascular Disease:  The Problems and Implications of Overlapping Affective Dispositions
Jerry Suls and James Bunde
Psychological Bulletin, 2005, 131(2), 260-300

Tuesday, May 17, 2011

The Heart and Emotions, From 1628

Angina of Emotion
Every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart.. A strong man who, having recieved an injury and affront from one more powerful than himself, and upon whom he could not have his revenge, was so overcome with hatred and spite and passion, which he yet communicated to no one, that at last he fell into a strange distemper, suffering from extreme oppression and pain of the heart and breast..’
Exercitatio anatomica de motu cordis et sanguinis in animalibus
W Harvey, Frankfurt-am-Main, 1628
P Taggart, H Critchley, P D Lambiase
Heart-brain interactions in cardiac arrhythmia
Heart 2011; 97:698-708


The link between heart and mind has been the subject of poetry and literature.  Now, thanks to neuroimaging and molecular cardiology, it is better understood scientifically.  

Express the emotion, out loud, in the open, appropriately, so it doesn't hurt you and those around you. Use your voice.  It is good for your heart.  

Sometimes we don't say it because we don't want to hurt others.  We can use our judgment.  If it is important, then saying it in a way that is respectful to self and others is not impolite or aggressive, it is assertive.

But what if that person is "more powerful" than oneself?  We are adults, we can use our judgment.  But this calls for developing (formal) leaders that are open to hearing questions and differences of opinion.  It also calls for the rest of us to assume (informal) leadership in certain situations.  I am reminded of an example in one of Malcolm Gladwell's books.   It was discovered that a Korean airline had a higher than usual fatal plane crash record because co-pilots declined to question or disagree with the pilot, out of a sense of tradition or respect for hierarchy, even when they knew they would die as a result.  Polite, maybe, but not safe for self and others.

Other times the risk of speaking out is more risky than not speaking out - on a physical, financial, emotional or social level.  You get to measure your risks.  You get to decide what you can live with and what you can't live with.  Just make sure you consider your heart, your rights, your thoughts, your feelings in the calculation.

No one matters more than anyone else.  So by all means consider the heart, rights, thoughts and feelings of others in the calculation as well.  I am concerned that historically oppressed peoples - women, people of color, adults abused as children - have learned to exclude themselves from this decision-making, negotiation and communication process.  At one time, it was a matter of survival.  Now it is a relic, a ghost of the past that lingers and can be vanquished.  It is safer now.  You are stronger now.  Take a small step at first with your freedom and power.  Learn to use it.  Practice.  Say it.  It matters.

Monday, May 16, 2011

Driven Underground

"Culina were also aware that Brazilians generally ridicule their traditional ethnomedical beliefs and practices, so they often simply concealed witchcraft illness from the missionaries."
Health Care Among the Culina, Western Amazonia
Pollack, Donald
Cultural Survival Quarterly (12) 1

Sunday, May 15, 2011

Concepts in Shamanic Healing

Excerpt from Kaiser Permanente Center for Health Research, Portland, Oregon study:
"Individuals who are 'dispirited,' who have chronic illness or pain, or who have experienced trauma of various kinds in their lives may particularly benefit from shamanic healing."
Definition of Concepts:

Soul loss, indicating a fracture of a person’s sense of wholeness, is often characterized as not feeling in one’s body. Soul retrieval brings back those soul essences that dissociated, often during trauma, restoring the individual’s sense of wholeness or well-being.

Power loss is characterized by feelings of helplessness and loss of power or energy. Power animal retrieval restores the individual’s connection with a spirit animal or teacher to help restore a sense of personal power.

Spiritual intrusion is characterized by pain, feelings that parts of the body are numb, and a sense of blackness or heaviness.

Extraction removes the heavy, negative energy from the individual.

Dispirited or low energy is characterized by an occasional awareness of other voices or negative energies felt in the spirit/body. Influence of ancestors or presence of non-living suffering beings may be interfering with the energy in an individual and are removed by depossession or psychopomp (helping a suffering being to go into the light).

FEASIBILITY AND SHORT-TERM OUTCOMES OF A SHAMANIC TREATMENT FOR TEMPOROMANDIBULAR JOINT DISORDERS
Nancy H. Vuckovic, PhD; Christina M. Gullion, PhD; Louise A. Williams, PhD; Michelle Ramirez, PhD; Jennifer Schneider, MPH
ALTERNATIVE THERAPIES, NOV/DEC 2007, VOL. 13, NO. 6 

Research in Shamanism

If you are a little freaked out by all the shamanism posts, you are not alone.  My husband has been asking me a lot of questions about my unusual/excessive interest in this traditional system of healing.  Is this a phase because of the class you are taking or are you really interested in pursuing a research program based on shamanism?  You want to be that lady?  You are not even out of the gate and already kicking up controversy?  He also says silly things to me like, "Don't squeeze the Shaman!"

1.  I am saddened that prior to taking this course (CHS M264 Latin American Medicine, Shamanism & Folk Illness - a graduate level and multi-disciplinary, not an "extension," course), I knew very little about Latin American Medicine.  This, despite the fact that my parents (and ancestors) were from Latin America!

2.  The readings -- with all their imagery, myths, symbolism, stories, and connections -- have fascinated me.  The information sticks to my brain, body and soul.  It is a healing tradition practiced the world over - Australia, Alaska, Siberia (originally), Asia, Korea, Africa, Medieval Europe, Latin America, and North America for thousands of years, with remarkable similarities despite great geographical distances.  It is practiced mostly by indigenous peoples who have experienced decimation of their population.  Those who survived suffered psychic murder.  The term, shaman, is viewed with ridicule, distrust, cynicism.  I guess I am a champion of the oppressed and those treated unfairly.  But really, despite the odds, the shamanistic complex has survived because it works. 

3.  I can't help but think that 30 years ago no one would have imagined a yoga studio on every corner in gentrified parts of town.  So if yoga - part of an ancient system of spiritual healing - can become mainstream, why can't shamanism or "shaman-like techniques"?

4.  My research and practice interests focus primarily on low-income ethnic minority urban youth and families.  I found a cool article that implemented a yoga intervention in schools with positive results.  Would a traditional system of healing that reflected the cultures of black and brown youth have an impact on multiple levels?  Some might point out that youth have about as much of a connection to African and Latin American ancestors as the average (white) American.  So among urban youth, there might be less cultural dissonance with yoga (it's mainstream American now) then there might be with shamanizing.  So sad!  No cultural resonance with your ancestors?  Is this tantamount to cultural soul loss? What if our youth knew that there are thousands upon thousands of ancestors who have got their back!!!!

5.  A couple of researchers (married couple) got together to conduct the first study examining the connection between mind and body.  Now there is a legitimate field called psychoneuroimmunology (mind-body) that brings together (hard-core) endocrinologists and immunologists in the same room with psychologists to look at assessments, interventions and outcomes of mutual interest.  Why not focus on Spirit in that Mind-Body puzzle?

Research Study
Okay, enough about my questions, connections and interests.  Kaiser sponsored a study, in Oregon, to examine the physical and psychological effects of shamanic treatment among women with temporomandibular joint disorders and several co-morbid physical/psychological disorders.  All of the subjects were white and so were the trained shamanic practitioners.  The shamanic treatments used in the study include:  soul retrieval, extraction (of negative intrusions), depossession, power animal retrieval, psychopomp, guided meditation, ritual or ceremony, soul remembering, body part retrieval, energy work/energy retrieval, curse unravel/cord cutting, spirit helper retrieved.  This small (n=20) pilot study showed statistically significant improvements in both physical and psychological symptoms.  It was the first clinical trial of shamanic healing, showed positive results and provided evidence for the feasibility, acceptability and safety of this type of treatment.

FEASIBILITY AND SHORT-TERM OUTCOMES OF A SHAMANIC TREATMENT FOR TEMPOROMANDIBULAR JOINT DISORDERS
Nancy H. Vuckovic, PhD; Christina M. Gullion, PhD; Louise A. Williams, PhD; Michelle Ramirez, PhD; Jennifer Schneider, MPH
ALTERNATIVE THERAPIES, NOV/DEC 2007, VOL. 13, NO. 6

Saturday, May 14, 2011

Cultural Diaspora, Loss and Confusion

Letter from Cree Woman in Prison:
"As you may be aware, in 1885 my family and band were spread all over this continent after the imprisonment of Big Bear . . . I’ve had a hard life and it keeps getting harder. I think it’s a deep sense of true justice and understanding and of true knowledge I search for that keeps me going . . . I just wish my life would change for the better at some point. I don’t want to die this way, with nothing settled or overcome. I need to fight. I need to know where I come from and why our race suffers so . . . "

A Cree Woman Reads Jung
Craig Stephenson
Transcultural Psychiatry 2003 40: 181  

Jung & Client Culture

No psychotherapist should lack that natural reserve which prevents people from riding roughshod over mysteries they do not understand and trampling them flat. This reserve will enable him to pull back in good time when he encounters the mystery of the patient’s difference from himself, and to avoid the danger – unfortunately only too real – of committing psychic murder in the name of therapy.
--Jung, 1937


A Cree Woman Reads Jung
Craig Stephenson
Transcultural Psychiatry 2003 40: 181 

Jung's Thoughts on Healing

"In order to understand and treat the sick in a multicultural society and in societies for which psychiatry is a foreign practice, psychiatrists are confronting the gulf and considering issues which they formerly dismissed as ‘metapsychological.’

The most obvious danger of applying notions of psychological healing from one culture to suffering in another lies in the very meaning of these terms, since ‘suffering’ and ‘healing’ are culturally entrenched.

As early as 1929, Jung acknowledged this dilemma in terms of a dichotomy between the psychologies of ‘West’ and ‘East.’ He wrote, ‘Western consciousness is by no means consciousness in general. It is rather a historically conditioned and geographically confined dimension, which represents only a part of mankind’.

This awareness led him to cautiously qualify and contextualize his psychological commentaries on texts from India, China, Tibet and Japan. For instance, ‘I will remain silent on the subject of what yoga means for India, because I cannot presume to judge something I do not know from personal experience. I can, however, say something about what it means for the West.’"

A Cree Woman Reads Jung
Craig Stephenson
Transcultural Psychiatry 2003 40: 181

Total Human

"Towards the end of his life, C. G. Jung issued a challenge to an international congress of psychiatrists: ‘It will assuredly be a long time before the physiology and pathology of the brain and the psychology of the unconscious are able to join hands. Till then they must go their separate ways. But psychiatry, whose concern is the total man, is forced by its task of understanding and treating the sick to consider both sides, regardless of the gulf that yawns between the two. . . .’ (Jung, 1958)."

A Cree Woman Reads Jung
Craig Stephenson
Transcultural Psychiatry 2003 40: 181

Shamans & Healing

"Shamans flourish in holistic cultures. In these cultures, individuals value harmony with their environment, cooperation and cohesiveness above mastery of and control over the environment, and holistic over dualistic thinking. They value the relational context of their lives and find comfort in extended family relationships. Indeed, they place the well-being of their extended family above their own. This kind of understanding of one's place in the universe—as an integral part of all things rather than as a separate entity—lends itself to a healing model of health and mental health. The shamans believe that their role is to provide or restore balance in nature so that everything is in its place. When there is disharmony, there is pain and suffering. Thus, they see themselves as being instrumental in removing an individual's pain and suffering and facilitating wholeness. Healing implies wholeness or a state of equilibrium. For the shaman, good physical and mental health imply not only that the individual is free from suffering, but also that the individual is in a larger state of equilibrium. That is, the individual is in a harmonious relationship with all things—with his biological, social, psychological, physical and cosmic environment. This implies that everything needs to be in balance for the human being to be whole, to be healed. Thus, for the shaman, healing requires much more than attention to the specific pain or suffering."

Journal of Child and Family Studies, Vol. 8, No. 2, 1999, pp. 131-134
Shamans, Healing, and Mental Health
Ashvind N. Singh

Fire Walker, this way...

Fire walking this week?  Let confidence be your guide. What rituals boost your attitude and outlook?

"Perhaps the best scientific studies of fire walking were conducted at the University of London in 1935 and 1937. Thermocouples were available to measure temperatures and the experiments were witnessed by several scientists and medical men.

In the 1935 walk, the surface temperature of the bed of coals was 430 degrees C. and the interior temperature, 1400 degrees. The walk was made by an Indian fire walker who traversed a 20-foot trench of coals four times without blistering. The English editor of the St. Bartholomew's Hospital Journal then walked half the distance before he jumped out and blisters formed on his feet.

In the 1937 experiment an Indian fire walker traversed a bed of coals with surface temperature of 740 degrees C. and was badly burned, while an English volunteer crossed the same trench with only slight burns.

On the basis of these experiments, Rawcliffe concluded that absence of fear is a vital point in fire walking. 'It is necessary to keep one's wits; for poise, correct pacing, and timing are all important. . . . Fear, by undermining confidence, spoils the walker's judgement. The initial rites therefore play a big role in bolstering up confidence'.

Other conclusions included:
(1) in the successful fire walk, skin surfaces should be in contact with the hot coals for only a few seconds
(2) that moisture is a disadvantage because hot coals may adhere to the skin and cause burns
(3) fear often produces sweaty feet so that once again absence of fear is important
(4) the untrained and inexperienced may fire walk as well as the experienced
(5) fasting, sexual continence, trancing, and other ritual preparations are unnecessary, except in that they may increase confidence and alleviate anxiety."

From footnote in:
Shamans and Endorphins: Hypotheses for a Synthesis
Author(s): Raymond Prince
Source: Ethos, Vol. 10, No. 4, Issue Devoted to Shamans and Endorphins (Winter, 1982), pp.409-423
Published by: Blackwell Publishing on behalf of the American Anthropological Association
Stable URL: http://www.jstor.org/stable/3696950 .

Hypnosis & Analgesia

"...the well-documented effect of hypnotic suggestion in the production of analgesia. The first surgical operation (an amputation at the thigh) was conducted in England by Topham and Ward in 1842. Elliotson (1843) reported many surgical operations using hypnosis in London, and almost at the same time, Esdaile (1851) reported similar procedures in Bengal. Both Elliotson and Esdaile were ridiculed by the Royal Medical and Chirurgical Society at the time.

Hypnotic analgesia was discovered at about the same time as ether analgesia and, since the latter was much more easily induced and widely applicable (although less safe), the use of hypnosis in surgery dropped from sight. Hypnosis analgesia is used today for a variety of procedures, including dental work, surgical procedures when the patient is unable to tolerate chemical anaesthetics, and in childbirth.

The current explanation as to why hypnosis can produce analgesia is that it is due to 'reduction of tension and anxiety, promotion of muscle relaxation, and diversion of attention from the pain stimulus'."

Shamans and Endorphins: Hypotheses for a Synthesis
Author(s): Raymond Prince
Source: Ethos, Vol. 10, No. 4, Issue Devoted to Shamans and Endorphins (Winter, 1982), pp.409-423
Published by: Blackwell Publishing on behalf of the American Anthropological Association
Stable URL: http://www.jstor.org/stable/3696950 .

Healing Practices

"Native Americans believe their healing practices and traditions operate in the context of relationship to four constructs—namely:
  1. Spirituality (Creator, Mother Earth, Great Father)
  2. Community (family, clan, tribe/nation)
  3. Environment (daily life, nature, balance)
  4. Self (inner passions and peace, thoughts, and values)."

From abstract:
International Journal of Disability, Development and Education
Vol. 53, No. 4, December 2006, pp. 453–469
Native American Healing Traditions
Tarrell A. A. Portmana* and Michael T. Garrettb
aThe University of Iowa, USA; bUniversity of Florida, USA

Cultural Soul Loss

One of the healing rituals that is a part of advanced shamanizing is recapturing the soul of a patient experiencing soul loss.  This typically involves a shaman entering a trance-like or ecstatic state and journeying on behalf of the client to find and bring back their soul from the underworld or lower world.

Among many indigenous peoples, the Huichol in Mexico and Afro-Brazilian groups, their cultural history - their travels and struggles - is periodically recreated in ceremony and ritual.  Remembering who we are and where we come from seems important to staving off cultural soul loss.

What do our black and brown youth in low-income urban communities know about who they are and where the come from?  Is there a way to tap into the knowledge and wisdom of the ancestors to restore harmony, balance and well-being in cities overwhelmed by violence and poverty?

In children's mental health, I hope that it is well established that families matter.  Can we also establish that culture matters?
The schizophrenic is drowning in the same waters in which the mystic swims with delight.
--Joseph Campbell

Friday, May 13, 2011

Excerpt from "The First Mind-Body Medicine..."

"The role of the shaman is to create order from disorder, to invite healing, cleansing, purification, and a realignment of the soul in a world where there is disorder, toxicity, and misalignment of living, thinking, feeling, and being.

These traditions are universal, transcultural, and pre-religious. They exist because we always have known suffering, loss, and illness. Confronted with spiritual, psychological, and biological suffering, we, as a species, have sought to create meaning for our suffering. These ancient traditions are easily dismissed as magical, imaginary, delusional, or meaningless collections of superstitious beliefs and behaviors.

While conventional science has accepted plant medicine and even now seeks cures from the 80,000 plant species of the rain forest jungles, it sees no relevance or context for shamanic practices for the suffering masses of the 21st century. How can the singing of songs, waving of feathers, or shaking of rattles solve any of our modern ills?

Shamanism is an integrated system of mind-body medicine. It was the first mind-body medicine, yet it contains more than methods to calm the mind or to shake off stress in a mechanical way. It provides a cosmology and architecture for healing not only the mind but also the soul, for navigating the confusion, injury, pain, or trauma we encounter as human beings walking the earth. Most modern attempts to adopt mind-body medicine such as biofeedback, breathing techniques, muscle relaxation, and massage may briefly relieve the symptoms of stress, but they do not address the root causes of suffering and stress.

Often medicine, plants, or relaxation are not enough to heal us. There must be something that creates realignment of purpose, meaning, and sense of place. There must be a way to reconnect to the inherent relatedness of us, one to the other, and to our place on the earth that sustains us.

More than stress alone contributes to or creates the majority of modern chronic diseases, from the epidemic of mental disorders including depression and anxiety to heart disease and more. Dis-ease is a disconnection from our sense of place in the world, from a loss of control and meaning...It is not poverty that increases the prevalence of illness, morbidity, and mortality but a loss of sense of culture, control, and meaning.

The shamans provide a doorway back to meaning, to a sense of place and control and order in our world. The mind-body understanding in health and disease needs to include not only tools for relaxation but also tools and rituals and context for realignment of the soul.

Systems biology and medicine (for which functional medicine provides a robust clinical model) operate from a similar framework.3 In order to create healing, the core systems of the body (meaning the body-mind and the mind-body) and the interrelationships or patterns that connect all these systems must be understood as a whole. Healing cannot occur out of context. Healing is created through an understanding of imbalance in each of the core systems and how these patterns of imbalance interconnect and influence each other. Once the imbalances are identified, factors that have created them (negative energies) such as poor diet, stress, social disconnection, toxins, infections, and allergens, must be removed (extracted). Then the ingredients for restoration and balance, such as quality food, adequate nutrients for restoration of optimal function, rest, sleep, exercise, rhythm, light, air, water, connection, love, and community, must be provided. Once the systems of the body are realigned, harmonized, and balanced, healing is possible.

The challenge of mind-body medicine is to embrace, contain, and include the human need for purpose, connection, and meaning."

THE FIRST MIND-BODY MEDICINE: BRINGING SHAMANISM INTO THE 21ST CENTURY
Mark A. Hyman, MD
Altern Ther Health Med.2007;13(5):10-11.

Dreams

The spirit of the depths even taught me to consider my actions and my decisions as dependent on dreams. Dreams pave the way for life, and they determine you without you understanding their language. One would like to learn this language, but who can teach and learn it? Scholarliness alone is not enough; there is a knowledge of the heart that gives deeper insight. The knowledge of the heart is in no book and is not to be found in the mouth of any teacher, but grows out of you like the green seed from the dark earth. Scholarliness belongs to the spirit of this time, but this spirit in no way grasps the dream, since the soul is everywhere that scholarly knowledge is not.
—Jung, 2009, p. 233
Found in:
Animals and Analysis: The Grimm’s Tale “The Three Languages”
Thomas Elsner
Psychological Perspectives, 53: 313–334, 2010
“If God says something is acceptable, don’t say it isn’t” (Acts 10:15 New Living
Translation).

Altered States of Consciousness

Both Christians and mainstream behavioral scientists have something in common - a decided distaste for shamanistic journeys and altered states of consciousness.  But check out the writings of Paul in the New Testament:

2 Corinthians 12:
"Let me tell you about the visions and revelations I received from the Lord. I was caught up into the third heaven 14 years ago. Whether my body was there or just my spirit, I don’t know. Only God knows. But I do know I was caught up into paradise and heard things so astounding they cannot be told." (vv 1–4)

Court (2010) describes the trance state, or an altered state of consciousness, as "a person being out of himself, in an absorbed and receptive state."  He goes on to add that "altered states of consciousness can be experienced with great benefit across a range of disorders and perhaps especially in pain relief."  He reports that before chemical anesthesia, hypnosis was the most effective method of pain relief.

This reminds me of a comment from a classmate who reported that after knee surgery, the only thing that seemed to alleviate the pain was a guided visualization CD that her HMO gave her for that purpose.

Clearly, this trance or altered state can be achieved by all sorts of religious and secular practices - meditation, guided visualization, hypnosis, drumming, prayer, dancing, and so on.

What are we afraid of?  Who taught us to fear and why?


Altered States in the Church and Clinic
John H. Court
Pastoral Psychol (2010) 59:411–422

Review of Mindfulness Research

Abstract

Objective: To briefly review the effects of mindfulness on the mind, the brain, the body, and behavior.

Methods: Selective review of MEDLINE, PsycINFO, and Google Scholar databases (2003–2008) using the terms ‘‘mindfulness,’’ ‘‘meditation,’’ ‘‘mental health,’’ ‘‘physical health,’’ ‘‘quality of life,’’ and ‘‘stress reduction.’’ A total of 52 exemplars of empirical and theoretical work were selected for review.

Results: Both basic and clinical research indicate that cultivating a more mindful way of being is associated with less emotional distress, more positive states of mind, and better quality of life. In addition, mindfulness practice can influence the brain, the autonomic nervous system, stress hormones, the immune system, and health behaviors, including eating, sleeping, and substance use, in salutary ways.

Conclusion: The application of cutting-edge technology toward understanding mindfulness— an ‘‘inner technology’’—is elucidating new ways in which attention, awareness, acceptance, and compassion may promote optimal health—in mind, body, relationships, and spirit.

Keywords: mindfulness; meditation; mental health; physical health; quality of life; stress reduction

Mindfulness Research Update: 2008
Jeffrey M. Greeson
Complementary Health Practice Review, 2009, 14, 10 originally published online 13 January 2009

Yoga and Asthma

Abstract

Background: There is a substantial body of evidence on the efficacy of yoga in the management of bronchial asthma. Many studies have reported, as the effects of yoga on bronchial asthma, significant improvements in pulmonary functions, quality of life and reduction in airway hyperreactivity, frequency of attacks and medication use. In addition, a few studies have attempted to understand the effects of yoga on exercise-induced bronchoconstriction (EIB) or exercise tolerance capacity. However, none of these studies has investigated any immunological mechanisms by which yoga improves these variables in bronchial asthma.

Methods: The present randomized controlled trial (RCT) was conducted on 57 adult subjects with mild or moderate bronchial asthma who were allocated randomly to either the yoga (intervention) group (n = 29) or the wait-listed control group (n = 28). The control group received only conventional care and the yoga group received an intervention based on yoga, in addition to the conventional care. The intervention consisted of 2-wk supervised training in lifestyle modification and stress management based on yoga followed by closely monitored continuation of the practices at home for 6-wk. The outcome measures were assessed in both the groups at 0 wk (baseline), 2, 4 and 8 wk by using Generalized Linear Model (GLM) repeated measures followed by post-hoc analysis.

Results: In the yoga group, there was a steady and progressive improvement in pulmonary function, the change being statistically significant in case of the first second of forced expiratory volume (FEV1) at 8 wk, and peak expiratory flow rate (PEFR) at 2, 4 and 8 wk as compared to the corresponding baseline values. There was a significant reduction in EIB in the yoga group. However, there was no corresponding reduction in the urinary prostaglandin D2 metabolite (11β prostaglandin F2α) levels in response to the exercise challenge. There was also no significant change in serum eosinophilic cationic protein levels during the 8-wk study period in either group. There was a significant improvement in Asthma Quality of Life (AQOL) scores in both groups over the 8-wk study period. But the improvement was achieved earlier and was more complete in the yoga group. The number-needed-to-treat worked out to be 1.82 for the total AQOL score. An improvement in total AQOL score was greater than the minimal important difference and the same outcome was achieved for the sub-domains of the AQOL. The frequency of rescue medication use showed a significant decrease over the study period in both the groups. However, the decrease showed a significant decrease over the study period in both the groups. However, the decrease was achieved relatively earlier and was more marked in the yoga group than in the control group.

Conclusion: The present RCT has demonstrated that adding the mind-body approach of yoga to the predominantly physical approach of conventional care results in measurable improvement in subjective as well as objective outcomes in bronchial asthma. The trial supports the efficacy of yoga in the management of bronchial asthma. However, the preliminary efforts made towards working out the mechanism of action of the intervention have not thrown much light on how yoga works in bronchial asthma.

The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial
Ramaprabhu Vempati, Ramesh Lal Bijlani and Kishore Kumar Deepak
BMC Pulmonary Medicine 2009, 9:37

Yoga in Urban Schools

This is a cool study looking at the impact of yoga on elementary school students in urban public schools.  

Urban youth are at greater risk for exposure to all sorts of traumatic events, especially community violence, which consequently puts them at greater risk of mental health problems like anxiety, depression and PTSD.  So it makes sense to provide an intervention that aims to help students regulate their emotions and behavior.  

I love yoga, but I wonder how an ancient and culturally specific healing practice that reflects the cultural history of the students studied might fare instead?  

Yoga is mainstream now and some might say that yoga's effects are universal so it doesn't matter who uses yoga for benefit.  

But might it matter to black and brown students who have no idea that behind them is more than a millennia of ancient wisdom to draw from?  What would happen if the ancient healing practices of black and brown students - practices dying out and relegated to the shadows - were studied empirically?  

Abstract
Youth in underserved, urban communities are at risk for a range of negative outcomes related to stress, including social-emotional difficulties, behavior problems, and poor academic performance. Mindfulness-based approaches may improve adjustment among chronically stressed and disadvantaged youth by enhancing self-regulatory capacities. This paper reports findings from a pilot randomized controlled trial assessing the feasibility, acceptability, and preliminary outcomes of a school-based mindfulness and yoga intervention. Four urban public schools were randomized to an intervention or wait-list control condition (n=97 fourth and fifth graders, 60.8% female). It was hypothesized that the 12-week intervention would reduce involuntary stress responses and improve mental health outcomes and social adjustment. Stress responses, depressive symptoms, and peer relations were assessed at baseline and post-intervention. Findings suggest the intervention was attractive to students, teachers, and school administrators and that it had a positive impact on problematic responses to stress including rumination, intrusive thoughts, and emotional arousal.
Keywords
Mindfulness, Yoga, Prevention, School-based intervention, Chronic stress

Feasibility and Preliminary Outcomes of a School-Based Mindfulness Intervention for Urban Youth
Tamar Mendelson
Mark T. Greenberg
Jacinda K. Dariotis
Laura Feagans Gould
Brittany L. Rhoades
Philip J. Leaf
J Abnorm Child Psychol (2010) 38, 985–994.

Monday, May 9, 2011

Healing & Wellness

Ancient healing traditions from all over the world recognize the relationship between mind, body and spirit - all three are connected and important in balance.

I interviewed a healer last week for a class paper.  What she said about fear resonates with everything I've read and know for sure - fear seems to be at the bottom of most individual and social ills.

In the DSM-IV, the diagnostic manual for psychological disorders, you will find two of the most common disorders that bring people in for therapy - anxiety and depression.  And many more suffer without any type of treatment.  Although there is a place for the full range of emotional expression, sometimes fear and negativity run rampant and unbalance us.

In the research literature, cognitive-behavioral treatment approaches have the most evidence of effectiveness for addressing anxiety and depression.  So if you are in treatment or seeking treatment for either/both, ask your practitioner about using this type of approach.

There are other approaches as well.  I have long explored alternatives to coping with the stressors of the past and the present.  Massages have always done the trick for me when life is tipping out of balance.  Scheduling regular massages is the best way to go (when I can afford it).  Acupuncture is an ancient healing practice that also works well for me.  Another of my favorites is acupressure.  I have released a lot with that modality.  When the pain shows up structurally, I run to my chiropractor.  They are all go-to ways to get back on track, in balance and feeling good.  A word of caution is that not everyone loves these approaches as enthusiastically as I do.  Some people dislike them or simply find no therapeutic value.  As most things, it's okay to find your own way.

Most recently, I have tried shamanic drumming, drum circles and energy healing - all old forms of medicine.  Millennium of wisdom that is always in danger of dying out, but as some believe, manages to survive because it works.

I'll write more about my experiences with each of these methods in later posts but in researching the literature about spiritual healing traditions and their health benefits, I was surprised to see so many studies looking at yoga, tai chi, meditation and drumming.  These practices were used to address all sorts of general and specific physical and psychological problems or wellness.

I am particularly interested in any experiences that you have had with drumming.  If you are a healer or have used drumming in healing, I would like to interview you.  Please contact me at aacunalcsw@gmail.com.  

Thursday, May 5, 2011

Collective Efficacy To Face Fear

"I told them I knew many powerful healers had tried to cure the illness, but it continued to reappear. They were afraid of the illness and uncertain of the future, but I believed that the ‘monster’ who inspired that fear could be defeated, but only if we stopped to face it together.

Then I shared this story about a double-headed snake monster the Salish people of the Pacific Northwest call ‘‘Sisquiutl,’’ or Fear. The fear monster is 60 feet long, as big around as the tree we are gathered around here. The heads on each end can see in all directions, so nothing escapes its sight. If
you were to come upon Sisquiutl, your first reaction would be to run, but as soon as you moved, the Fear Monster would see you and come after you until it caught you and ate you. After you move, which happens instinctively, you have to stand still.  Having seen you twitch reflexively, it will come after you. But standing still, it approaches you slowly, first one end and then the other, until it has you trapped between both its heads.  Suddenly, seeing itself reflected in its own eyes, it becomes so horrified by its own image that it slinks away in horror.  The only way to escape the fear monster is not to run because fear always runs faster than you can. If we stop running and face it together we can defeat the monster and make the illness go away."

From: The Huichol Offering: A Shamanic Healing Journey by Carl Allen Hammerschlag in the J Relig Health (2009) 48:246–258.