Yoga

Selecting Your Exercise program

The real task is to find a form of exercise that you will find enjoyable. Joy not just in having gone through the workout but pleasure in actually doing the activity. When you find such an activity you will have won a major part of the battle in being able to sustain a program.

What are your personal goals when it comes to exercise? Do you strive primarily to attain health benefits? Are you interested in adding more everyday activities/lifestyle choices to meet a minimal level of exercise? Does gym membership interest you? If so, are you more interested in individual or group fitness options? If group activity is important to you have you investigated what types of classes are available? Is there a sport or sports that interest you that you would like to explore? Has your doctor recommended that you exercise, do resistance training for bone health, encouraged you to seek increased flexibility to reduce the risk of injury and accidents?

Or, do you already exercise but feel you have reached a plateau from which you would like to advance or are you considering moving from being a casual runner to preparing for and beginning to compete in road races of various lengths? There are master level competitions in many activities—so don’t let the passage of time prevent you from pursuing the idea of competition if that appeals to you. Or maybe you have exercised on your own for awhile and are now interested in joining a group or feel confident enough to join a gym? It is not true that you have to be in shape to go to a gym—there are plenty of couch potatoes trying to change their ways mixed in with those who already have experienced the advantages that come from regular exercise.

You also need to consider whether you are a morning or night person—if you are a night person you will learn to hate any activity that requires you to be at the gym at 5:45 am several days a week. A morning person will also not much care for vigorous activity in the evening during the time that person normally begins to wind down from the day. Are you self-motivated or do you need the pressure of schedule to keep you on track. Do you crave routine or do you relish change? Do you need to design your own program or would you be more satisfied by having someone else do this for you?

All of these factors can influence your choice of the correct program for you. It also helps to keep an open mind and try different things in the search to discover what types of activity bring you joy. You may find, for example, that running gives you a wonderful endorphin rush but yoga gives you a sense a calm and the flexibility to keep running. There is no reason why you cannot do both.

Stress and Health

There is growing evidence that stress is a major factor in maintaining health and well-being. Health means more than the absence of illness. In China and in ancient Greece health was thought of as being in balance with nature. The vital task was seen as maintaining equilibrium in the face of extensive demands. The World Health Organization (WHO) definition of health is a state of complete physical, mental and social well being.

It seems increasingly clear that the naive notion that a germ automatically leads to illness is no longer acceptable, although much of the lay public subscribes to the theory. Today we know that the idea of a single external cause, such as a germ, is oversimplified. The presence of the germ does not always cause the illness. The vulnerability of the person or the host animal is a major factor and that vulnerability is influenced by such factors as immunity and stress levels. So the cause of illness is not quite as simple as we once thought.

Stress vs. Distress

Another important distinction that came out of the seminal work of Hans Selye is between stress and distress. Both involve demands on the person to adapt to a challenging event. However, when we appraise the situation as being something we can handle it can be an exhilarating experience. When a person appraises the event as beyond their ability or as exceeding resources the situation is experienced as distress. Another way to look at it is that stress is positive and distress is negative. It is a valuable distinction since many people believe all stress is bad for you. It is not.

The diathesis-stress theory

The diathesis-stress theory of the origin of certain illnesses holds that we are born with certain biological predispositions but that whether or not an illness manifests itself is dependent on the level of stress one experiences and the resources one can use to overcome the stress. For example, although a person may have inherited a genetic deficiency in metabolizing alcohol, whether that person becomes an alcoholic or not also depends on the types and levels of stress they experience. Another person may have inherited a problem with glucose metabolism; however, it is factors such as the level of stress, or a sedentary life style or a combination of the two that result in development of type 2 diabetes. We may be born with certain vulnerabilities; it is stress that tips us into active illness.

Impact of stress on illnesses

Certain ailments have been recognized for some time as being influenced by stress. The most common example is intestinal distress such as indigestion and colitis. Other disorders like migraine, tension headaches, high blood pressure, arthritis and certain skin disorders may also be influenced by stress. In some instances, stress emotions seem to make an ailment worse, while in others stress may be a factor in bringing on illness. Research increasingly supports the hypothesis that stress may have at least some impact on many diseases.

There are several reasons for believing that stress contributes to the development of cardiovascular disease. First, stress emotions increase the level of low-density blood cholesterol and this leads to clogging of the arteries of the heart. Second, stress emotions result in maladaptive coping behaviors such as smoking, drinking and overeating, which can damage the heart and surrounding vessels. Finally, stress emotions result in the release of powerful hormones which result in increases in heart rate and blood pressure. One of these stress emotions is anger, and anger expressed in the form of hostility is known to increase the risk of cardiovascular disease.

Several hypotheses are being explored in the role of emotions in cancer. Again stress emotions may play an indirect role leading the person to smoke or drink excessively. More direct influence is attributed to a tendency to suppress or deny emotions. There is some evidence that those who suppress emotions are more susceptible to cancer. Again the mediating factor is hormonal activity.

At the 2002 meeting of the American Psychological Association a group-based stress management study was presented that indicated that group stress management training could lower blood glucose levels in Type 2 diabetes. Patients that received instruction regarding the health consequences of stress and instruction in the use of cognitive and behavioral skills such as deep breathing and recognition of major life stresses as well as instruction in progressive muscle relaxation lowered their glucose levels more than patients that did not have stress management training. Thirty-two percent of the patients receiving stress management lowered their A1C glucose levels by one percent or more as compared to 12% of the patients who did not receive this training. This modest change is larger than the half percent change that has been associated with significant reduction in microvasclar complications that can accompany out of control diabetes. While this change might move someone with tightly controlled diabetes to near normal levels; even those diabetics with poorer control would benefit from the reduction in glucose levels with fewer diabetic complications.

In summary, if you are a type 2 diabetic, learning to manage stress should have special health consequences for you. Although this was a group program, if none is available in your area, individual stress reduction strategies should be beneficial, especially if you have a friend or family member trying to learn stress management with you.

Stress and the immune system

The immune system has been called our liquid nervous system. With our growing knowledge of the human body has come an increasing conviction that stress may be a factor in susceptibility to colds, flu, mononucleosis and other infectious illnesses. It appears that some of the hormones secreted in the presence of stress emotions impair or weaken the immune process by reducing the number of disease-fighting components such as lymphocytes (white cells) thus leaving us more vulnerable to infection. This may be one of the reasons why so many people die within a year or so of their spouse’s death. Recently there has been research into why some HIV positive patients develop full blown AIDS while others do not. One interesting finding is that patients with a more effective style of coping with stress seem to have stronger resistance as a result. It is now reasonable to hypothesize that stress emotions increase secretion of certain hormones. These hormones weaken the immune system and that weakness results in an increased likelihood of infectious illness.

Recent research indicates that brief time-limited stress that may be viewed as a challenge (e.g. passing an exam, good performance in sports, solving a difficult puzzle under pressure) may actually enhance the body’s immune response. However, chronic stress seems to reduce the effectiveness of the immune system and thus make the person more susceptible to diseases.

Happiness and Joy

People have been concerned about happiness for millennia. Two thousand years ago Seneca observed that his forefathers lived as well as they were living during his time. This was in spite of the fact that his forefathers found shelter in the ground, used their own hands to obtain and dress their meat and did not know the pride of owning and wearing gold and fine gems. He commented that it was what was in the mind that made a person rich: no one could be considered poor who had enough, or rich if they wanted more than they have.

Seneca’s observation is consistent with the Chinese saying from long ago that a person who is content is always happy. People can become so interested in acquiring things that they recklessly pursue fame and fortune. Living life in this manner limits people to the demands of fame and the restrictions of wealth. Their life energy is spent in pursuit of fame largely for the purpose of obtaining wealth. Ironically if you actually obtain great wealth it also opens the door to the possibility of great loss, including robbery, burglary, or even murder as others attempt to take what you have. On the other hand, the person who is content with what he has can spend his life energy in more truly satisfying endeavors. People who are content are said to be rich in the quality of their life, which is likely to include tranquility, peace and spiritual nourishment.

Today happiness researchers continue to find validation for these ancient concepts. Modern happiness researchers define happiness as a state of well-being which depends less on our circumstances and more on how we respond to them. While national affluence and a sense of well-being correlate, there is a stronger link between a secure democracy and well-being. In fact, the capacity for personal choice is a greater predictor of happiness than a country’s relative wealth. While indigent people concerned about losing the most essential necessities of life endure a sense of hopelessness, wealth alone does not guarantee a sense of purpose and life satisfaction.

People need enough money to provide the basic necessities of life on a continuing basis. However, having more than enough does not really boost our sense of well-being. This is because when we have the basics other needs come to the forefront—things such as a need for a sense of belonging, or a feeling that we are making a difference by our existence. The first serving of food tastes better than the second helping. In the same way once humans have basic rights, shelter, adequate food, meaningful activity in their lives and enriching friendships our level of happiness is surprisingly unaffected by more money. There is only a slight tendency for those who make lots of money to be more satisfied with what they have. True satisfaction is not really about getting what you want but wanting what you have. Larger incomes also don’t influence how satisfied we are with our spouse, children, friendships or even ourselves, but all of these relationships are important in determining our sense of well-being, i.e., our happiness.

Traits of happy people

Researchers have found that there are four inner traits that predispose positive attitudes and happiness. These traits are:

• Self-esteem – happy people respect their value as a human being. When things get tough people with a firm sense of self-worth keep going.
• Personal Control – happy people feel like they have control over what happens to them. They feel like they can control their destiny.
• Optimism – happy people are filled with hope and expect to succeed when they try something new. They see the proverbial glass of life as half full, not half empty.
• Extraversion – happy people tend to be outgoing and sociable.

Even in old age extraverted individuals tend to be cheerful and full of the joie de vivre, the joy for living. People who like themselves are confident that other people will like them too. They have many friends and they engage in rewarding social activities. More fulfilling social interactions result in their experiencing more affection and greater social support. This is very important because social support is the foundation behind their sense of well-being and positive outlook on life.

Becoming a happier person

Just because you are not born an extrovert with high self-esteem and an optimistic outlook does not mean that you cannot make changes in that direction. Pretend you are self-confident, pretend to be optimistic, try to be more outgoing with others. Research has shown that while telling people to act or talk positively sounds like you are asking them to be phony, in reality when people follow through and practice these traits amazing things happen. The phoniness gradually diminishes and the new behaviors and accompanying attitudes begin to fit, like a favorite comfortable pair of old jeans.

If you doubt this strategy force yourself to put on a big smile. Now frown, tighten your jaw and try to look angry. Try both again and this time pay close attention to how you feel. Can you tell a difference? Research shows that if you smile on the outside you will feel better on the inside.

The same goes for your interactions with other people. Smile. Act like you like someone and you may just find out that you do! And, as a bonus, you may also find out that you are beginning to like yourself better, that you feel more confident and that you are becoming more comfortable with other people. And these are the changes that can help you feel greater happiness in your life and more optimism for the future.

Causes of Anger

Two common causes of anger are a feeling of encroachment in areas we hold precious, and feelings of abandonment when we lose things we hold dear. If another employee gets the promotion that we feel we should have been ours, we can be very angry at that person for “stealing” our opportunity, or at our boss for being stupid and passing us over. If we are threatened by the loss of a close friend or spouse we can feel very angry at their “betrayal.” This second type of anger may contain holdovers from childhood when adults let us down, leaving us feeling abandoned. When we experience a current situation that suggests we are being unfairly abandoned it reinforces and justifies our sense of outrage.

As adults our feelings of protectiveness extend to family members or beliefs that we cherish. Sometimes this can flow into areas where a cool head would be more appropriate. If our child is passed over for an award or is not given enough time at bat we may feel angry because our loved one has been “mistreated.”

Thus anger can be considered:

• A response you learned early in life to help cope with pain and fear
• A temporary way to overcome feelings of lack of control or helplessness
• A habit you do not know how to break.

Anger can co-exist with other emotions

In spite of its frequent occurrence, anger may be considered a secondhand emotion. It is preceded by feelings such as fear or pain. In fact some experts describe anger as an afflictive emotion because of its association with pain, suffering, or injury. Moreover, some of the physiological responses to anger and fear are the same, even though we acknowledge different feelings. It is our psychological interpretation of the experience of an epinephrine rush that gives the experience meaning. Is that sinking feeling in your stomach, the sweat on your brow or the nervous palpitations of your heart a sign of fear or anger? Ask yourself: Does the present situation threaten you with personal or professional embarrassment? Do you feel like someone is taking advantage of you or preventing you from doing something you want or need to do? Is there something about this situation that evokes one of your anger triggers? If so then you are probably becoming angry in addition to whatever else you may be feeling.

Some anger is an alternative or substitute emotion

Anger can temporarily protect you from having to deal with threats suggesting personal weakness. Getting angry helps you hide from others that you find a situation frightening or that you feel vulnerable. An angry person feels powerful. However, angry outbursts only work temporarily. Anger does not resolve the problems that made you feel fearful or vulnerable in the first place. The challenge is to learn how to use your anger productively.

Physiology of anger

Our bodies let us know when we are angry. For example, when we encounter one of our emotional triggers we begin to feel tense. Hormones called catecholamines are released which cause us to experience a burst of energy. This initial burst of energy lasts several minutes. Next hormones, such as adrenaline and nonadrenaline are released, which can keep us in heightened aroused for hours or even days. This is why a rather minor irritation can cause you to explode in anger if it is preceded by an earlier upsetting episode. In any case, once we begin to experience these physiological changes our face flushes, our heart rate accelerates, blood pressure rises, respirations increase.

Although some major elements are the same in the face of fear and anger our interpretation is different. We say we are “hot and bothered” when angry and “cold and clammy” when afraid. This is because while our heart rate may go up in both instances, skin temperature changes are different. Our skin temperature increases when we are mad which is why we feel “hot” or that we have “lost our cool.” In contrast, when we are afraid our skin conductance drops and we feel cold.

Polarizing effect of anger on attention, memory

When a person is attending to something they are interested in, such as watching a play or listening to instructions explaining how to do something they really want to do, their heart rate drops. Even babies show a heart rate drop when attending to something of interest to them. If a person is trying to concentrate on a problem and must block out distractions their heart rate rises. Thus if you are trying to block out your feelings about the guy that cut you off and nearly caused a wreck as you were driving to work, your heart rate will be elevated and you will have greater difficulty concentrating than if you were attending from a more neutral perspective.

In fact, epinephrine and norepinephrine fuel many emotions. These hormones help the brain learn and enhance memory, concentration and performance up to a point. However, when the body becomes flooded with epinephrine you become too excited and concentration and performance decline. If you become too aroused you are like a deer frozen in the headlights of an approaching car. This is why you cannot remember the details of a really explosive argument, although the person you were arguing with and who was not as angry has a clear memory of what transpired.

Motivational effect of anger

The physiological experience of anger energize us for vigorous action. Anger mobilizes actions to strike out at the threat. It gives us the determination to go forward.

Anger:

· Gives a sense of power and control

· May motivate a person to change a personal weakness

· Defends a person against feelings of guilt, fear, grief, hurt, pain, sadness, and helplessness

· Can help you get what you want, at least temporarily

· Can point out social wrongs and motivates you to work to change them

· Gives a sense of power

· Minimizes a sense of inadequacy temporarily

· Gives you the resolve to leave an abusive situation

· Allows frustration to be vented and tension released

· Makes you appear superior, or powerful

· Makes you feel justified in your beliefs

· Helps you see that you are not getting what you want

· Gets you attention from other people

· Can be used to coerce people to do what you want them to do.

Appraisals and Stress

Richard Lazarus conducted research on stress and emotions for four decades. He found a link between appraisals and stress. An appraisal is an evaluation of the significance of what is going on between the person and the environment in terms of that person’s well being. Appraisals establish the meaning of an encounter for us. At its simplest level, it is a quick assessment of what is going on and then what we can do about it. If we confront a snake, the first appraisal may be that it will harm us (e.g. it kills) and quickly, on the heels of that appraisal, we evaluate what we can do about it (e.g. move quickly away). These appraisals are instantaneous and automatic.

In understanding the role of emotions in regulation of stress the distinction between a primary and a secondary appraisal is most helpful. A primary appraisal is an evaluation of whether something (e.g. a snake) is of relevance to our well-being. What is our stake in the event (e.g. not being bitten)? A Secondary appraisal is an evaluation of our options for coping and expectations about what will happen.

Another key concept in understanding our capacity for self-regulation is coping. It is defined as activity to manage demands that tax or exceed our resources. When demands exceed our resources we experience stress. There are two important types of coping:

· Action-focused – which involves making changes in the environment (e.g. killing a snake

· Emotion-focused – which involves changing the way we interpret or we experience the event (e.g. “Oh, it’s not poisonous.”)

It is useful to view stress as having four stages:

Stage 1- Environmental demand

Stage 2- Perception or appraisal of the demand

Stage 3- Physical and psychological response to stress

Stage 4- Behavioral consequence or performance

An event in the environment makes a demand on the person. That demand is not automatically a source of stress unless the person views the event as a threat or that an adequate response may stretch the capacity of the person. In Stage 3 the body may show signs of increased tension and arousal (e.g. increased heart rate, perspiration, rapid breathing) and a flood of thoughts. Finally the person acts in a way that may either reduce the level of tension or increase it further, and the cycle renews at Stage 1. If the behavior succeeds in meeting the demand, the person will approach similar demands in the future with greater confidence. Learning is very important in determining our response to stress.

Stop Smoking

Nicotine activates the pleasure center of the brain. Within 10 seconds of inhaling a puff on a cigarette nicotine levels peak in the brain. The average smoker takes about 10 puffs on every cigarette smoked. Since the pleasurable effects of nicotine are short-lived the smoker soon craves another cigarette. If one cigarette supplies ten surges of nicotine to the brain, smoking 1½ packs of cigarettes a day provides a smoker 300 nicotine hits. Since cigars and pipe smokers usually do not inhale, their nicotine must be absorbed through the mucosal membranes in the mouth. The mucosal membranes are also the entrance way for nicotine delivered from smokeless tobacco. These other forms of tobacco use may not delivery their nicotine fix as efficiently as a cigarette, but it is delivered.

Some smokers say that smoking relaxes them while others say that it gives them a boost. According to the National Institute of Drug Abuse, nicotine does both—acting as both a stimulant and a sedative. A hit of nicotine stimulates the adrenal glands which cause a release of adrenaline. This release of adrenaline stimulates the body and causes a release of glucose, as well as an increase in respiration, blood pressure and heart rate. Meanwhile insulin output is suppressed which leaves smokers with slightly elevated levels of glucose in their bloodstream. Nicotine also causes the release of dopamine in the part of the brain that controls pleasure and motivation. A similar effect is caused by cocaine and heroin and is believed to be behind the pleasurable sensations reported by many smokers. Nicotine is also able to cause a sedative (calming) effect depending on a smoker’s nervous system arousal and how much nicotine is taken. These effects occur with the use of all tobacco products; cigarette smoking merely provides the most rapid dosing.

Frequent use of tobacco products results in addiction to nicotine. Repeated exposure to nicotine results in the development of tolerance for the drug. As tolerance is build it takes a higher dose of the drug to produce the same level of stimulation. Nicotine is metabolized rapidly which means it disappears from the body in a few hours. Thus morning doses of nicotine have a greater physiological effect on the body than those occurring later in the day because of a period of abstinence during the night.

The addictive properties of nicotine contribute significantly to the difficulty tobacco users have in giving up the habit. The withdrawal symptoms from discontinuing nicotine use can be challenging and often drive people back to tobacco use.

Psychological factors also influence the difficulty experienced by a user trying to break an addiction to tobacco. The pleasurable consequences of smoking are considerable and they affect not only the body but also the mind. While we rarely think of tobacco use as an addiction of the same caliber as a craving for cocaine or heroin, tobacco’s legal status does not prevent it from being highly addictive. Nicotine is a drug. The initial high from obtaining a hit of the substance relieves the immediate craving for the drug, which may be followed by the user feeling calm and relaxed. Unfortunately this satisfaction is very short-lived and a new craving quick to develop. A person attempting to quit smoking will miss the boost a cigarette gives them and/or the calming effect they perceive. Tobacco has become a dependable friend.

Psychologically, when you quit using tobacco you may go through a period of mourning for your longtime friend. Dr. Kübler-Ross analyzed the stages that human beings go through when in grief. The stages are: denial, bargaining, anger, sadness (depression), guilt and acceptance. It is definitely not an indictment of you if you miss smoking as a kind of friend and companion. It has been a big part of your life for a long time. Be kind to yourself if you have these feelings; they are part of being human. Work through the stages and they will set you free to go on as a non-smoker. Think positively. You can do this.

Learning To Relax

Attention Focus and Relaxation Page

Harry L. Mills, Ph.D.

There is growing evidence that one of the most important factors in development and treatment of emotional disorders is attention. In anxiety a bias develops and patients attend to certain events more than others. Or they turn attention inward rather than outward toward the world in which they live. Thus to address many of the emotional issues that arise in LTC the therapist must assist the patient in mobilizing attention in the service of health.

Patients tend to think that their attention is the slave of events in the world around them. Events control attention. In our daily routine we are bombarded with sights and sounds. When we try to rest we often find wave after wave of thoughts and worries constantly intruding. Wells and his colleagues (Wells, 2001) developed a simple exercise that teaches the patient how much control they can exert over attention. In LTC this exercise can be done outside the building at least initially. Participants are asked to focus on a fixed visual point. Then the therapist identifies a series (3 to 9) of sounds and asks the patient to focus on those sounds. Then the patient is told to switch to each sound on their own. This procedure is less effective with those with hearing impairment. With such patients I use switching attention to visual cues. The important aspect is to show the patient that the focus of attention is under volition and need not be a slave to events. Also they prove to themselves that they can choose to extract attention from internal events to the external world.

Many patients simply try to suppress a thought or image. That leads to frustration. I usually try another simple experiment. I tell them no matter what they do they are NOT to think of an elephant. They usually smile. And I say the lesson is that you can only replace a thought with another thought or an image with another image. And the only way to get out of their head is to focus on some specific sound or visual cue in the world out there. We are meant to live in the world and not in our heads.

Meditation is a special form of attending. Everyone has meditated but may not know they have done so. However, when the word is used one may think of saffron robes and bearded gentlemen in contorted positions. If so that is too bad. Meditation is simply putting one’s mind at ease and using special methods of attention. It is a skill and is tied to no particular religious point of view. And it is a skill that can be learned.

While many still viewed meditation as an activity for kooks, Dr. Hebert Benson, a cardiologist at Harvard Medical School and Deaconess Hospital in Boston, decided to study it systematically. As a result of his research, meditation has enjoyed widespread acceptance in the west. School teachers meditate, CEOs meditate, and people concerned about anxiety are making meditation a part of their lives.

Mindfulness is a word that means focusing attention, in a non-judgmental and accepting way, on what we are doing right now, not on what happened yesterday or what might happen tomorrow. One way to learn more about mindfulness is to focus on the experience of eating a favorite food. Many people use an orange cut into wedges for this exercise. Others people prefer to use a mango or even candy or raisins. To introduce mindfulness have your patient pick a favorite food and then try this exercise:

· Take a few deep breaths and relax the body.

· Scan the body and release tensions.

· Let go of the past and the future, and bring attention to the present moment.

· Let the attitude be open and receptive.

· Take a moment to appreciate where the orange (mango, or raisin) came from; look carefully at its color, texture, shape.

· Notice the aroma.

· See, as if for the first time, how it is formed.

· Eat one section of orange, piece of mango, candy or raisin at a time, very slowly, as if one had never tasted this food before.

· How does one chew? On one side of the mouth, the other, or both? How many times do one chew before swallowing? Above all do not hurry.

· Whenever one notice any distraction from the moment-to-moment experience of eating, stop, take a deep breath, and then continue.

· Allow feelings of enjoyment to arise as one experience the pleasure of eating mindfully.

This exercise shows what the experience of eating is like when one attends completely to what one are doing. That is a better introduction to mindfulness than talking about it for hours. Once your patient has tried this or a similar exercise select with them some activities during the next week during which they can try to attend completely to what they are doing at the time they are doing it. It can be as simple as sitting. Or it can be while eating. Thoughts will intrude and the patient should be led to expect that. But then return attention to what they are doing.

Thomas Marra (2005) suggests a mnemonic to teach mindfulness: ONE MIND

· One thing in the moment

· Focus on the now

· Pay attention to the environment

· Pay attention the immediate moment

· Increase the senses of touch, taste, vision and hearing

· Take a non-judgmental stance

· Describe in words that are descriptive

There are two posters that I put up in the patients room:

DO ONE THING AT A TIME

ALWAYS BE WHERE YOU ARE

Americans like to stay busy and judge everything by the numbers. If we are not running from event to event we feel guilty. Meditation requires pausing for at least a brief time each day. It involves sitting still and focusing attention on what happens when sitting still.

One of the best introductions to meditation to your patients is with meditative breathing since breathing properly is a key to relaxing. Have the patient try these steps:

• Put on comfortable loose clothing. Sit down on the floor in a comfortable position. Or, sit in a chair with good back support.
• Scan the body for tension. Notice any tension just imagine it is draining away and being replaced by relaxation.
• Just begin to breathe through the nostrils in a relaxed way. Breathe from the abdomen. Some people imagine a balloon just under their belly button that inflates and then deflates.
• As one inhale count one. Exhale slowly. Then on the next inhale count two. County silently up to ten.
• If one find distracting thoughts just return to the count.
• Keep the focus on breathing, attending to each in breath for its full duration and each out breath for its full duration, as if one were riding the waves of oner own breathing.
• Every time one notice that one’s mind has wandered off the breath, notice what it was that took one away and then gently bring attention back to the belly and the feeling of the breath coming in and out.
• If the mind wanders away from the breath a thousand times, then the “job” is simply to bring it back to the breath every time, no matter what it becomes preoccupied with.
• Become aware of thoughts and feelings at these moments, just observing them without judging them.
• After one have completed the count to ten one can add a word like ONE or CALM or AMEN as one exhales.

Dr. Benson, has made a study of the counterbalancing mechanisms of the body’s stress reaction. He discovered that while the fight-or-flight response is part of the hard wired response to stress, there is an opposite response, he called the relaxation response. The relaxation response causes the body to calm itself. Metabolism decreases, heart rate decreases, blood pressure decreases, breathing rate decreases and muscle tension decreases. Dr. Benson has discovered that the relaxation response can be elicited by a number of techniques including:

• Diaphragmatic breathing
• Meditation
• Yoga
• Body scan exercise
• Mindfulness meditation
• Repetitive exercise
• Progressive muscle relaxation
• Imagery
• Repetitive prayer

Those who elicit the relaxation response regularly, such as on a daily basis, report these kinds of changes:

• Improved sleep
• Decrease in stress-related symptoms
• Decrease in anxiety
• Increase in concentration and awareness
• Greater self-acceptance
• Enhanced performance and efficiency.
• Freedom from compulsive worrying, self- criticism, negative thoughts

There are the basic steps in learning to elicit the relaxation response:

· A mental focusing device, such as attending to your breathing, or repeating a word, phrase, prayer, sound, to help shift the mind from everyday worries. He suggest use of the word ‘one’ or ‘calm’ as a device.

· Gently direct the mind back to relaxation exercise when you getting caught up in a train of thought. Keep a passive attitude toward distractions.

Possible instructions for patients to elicit the relaxation response include:

Step 1: Pick a focus word, phrase, image, or prayer.

Step 2: Sit quietly in a comfortable position.

Step 3: Close your eyes.

Step 4: Relax your muscles.

Step 5: Breathe slowly and naturally, and as you do, repeat your focus word or phrase as you exhale.

Step 6: Do not worry about how well you are doing. When other thoughts come to mind, simply say to yourself, “Oh well,” and gently return to the repetition.

Step 7: Continue for ten to twenty minutes.

Deep breathing is the body’s natural way to relax. We seem to know how to breathe as children but as we grow up, we forget. We tend to breathe in a very shallow way in the upper part of the chest. Try these instructions with your patients:

• Lie down on a bed or on the floor. Bend your knees and relax your toes. Keep your spine straight. If need be put a small pillow under your lower back for support.
• Scan your body for tension. Imaging the tension just draining away.
• Place on hand on your abdomen and one on your chest.
• Inhale slowly and deeply. Notice which hand moves the most. For many people it is the hand on the chest.
• Continue breathing deeply. Concentrate on moving the hand on your abdomen more than the hand on your chest.
• Continue this for 5 or 10 minutes. This is a way to learn abdominal breathing and to learn to breathe yourself into relaxation.

Before getting into mindfulness and deeper methods you may want to lay a foundation by introducing relaxation in its more basic forms as with this excellent starter script (1992, Lusk):

• Begin by closing your eyes…and releasing the air in your lungs.

• Take in a full, deep breath through your nose, allowing your lungs to fill up completely, letting the air go all the way in…and then sighing it out through your open mouth. Release all of the tiredness, tension, and negativity with your breath.

• Take in another deep breath…And sigh it out. Take your time…Breathing in…and out.

• Pause for 20 seconds

• Now let you breath return to normal.

• In a minute or so, I will begin to count from 1 to 10. As I count up, you will slowly begin tensing all the muscles throughout your body: your arms and legs, your torso and back, your shoulders and face. At the count of 5, your body will be half way to being tense all over.

• By the count of 10, you will feel tension and tightness throughout your entire body.

• Then I will count backwards from 10 to 1. As I count down, you will slowly release the tension in your body. By the count of 5, you will be half way to being completely relaxed. At the count of 1, your body will be completely relaxed. Then you will take in a big breath and then sigh it out.

• Now sense how your body feels as it presses firmly against the floor. Become aware of how your body is feeling right now—your legs, back, arms, and head. You are becoming acutely aware of how you are feeling in your physical body right now. Physically…how your body feels to you. Just become aware.

• Let’s begin. 1…add a little tension…2…add some more…3…4…5…you are half way there…6…7…8…9…and 10.

• You are all the way there now. Feel the tension. Know it and experience it completely so that you will be able to recognize muscular tension and tightness later on.

• 9…relax a little bit…8…a little bit more…7…6…5…and you are half way there…4…3…2…and 1.

• Dissolve and release all of the muscular tensi9on and tiredness. Let go completely…Experience the feeling of being completely relaxed and calm…Soak it in…Learn to recognize the feeling of relaxation.

• If you still feel some muscular tension, you will find that you can relax even more if your mind gives your body permission to relax. Let those spots relax now by mentally giving yourself permission to relax…It’s OK to relax…Just let it go.

• Take in a long, deep breath and sigh it out, letting the air rush out through your open mouth. Keep the air out of your body until you are no longer comfortable, then take in another deep breath and sigh it out completely…Notice that you can relax more and more, each time you exhale.

• Pause for 20 seconds

• Now let your breath return to normal.

• Notice that you feel as if you are sinking into the floor. Let the floor support and hold you, safely and securely.

• Your body feels as if it is being supported entirely by the floor. Every time you breathe out, feel more and more relaxed, calm, and serene.

• Now draw your attention to your mind…Notice what thoughts are drifting through your mind right now…Let your mind and thoughts become silent and still so that you can begin to center in and concentrate more.

• If your mind begins to wander, gently bring your attention back to the sound of my voice or to the motion of your breathing.

• Now notice how your emotional self is feeling right now. What kind of mood are you in? Try not to judge your mood, just recognize and accept what you are naturally experiencing at this moment.

• Each time you exhale, notice that you feel more and more settled and are feeling a sense of harmony and balance occurring within your body, mind, mood, and spirit. Feel this sense of balance within your body…mind…and emotions.

• Start to picture the room you are in…the walls, the ceiling, the floor.

• Describe different aspects of the room.

• When you can picture the room completely, open your eyes and stretch.

A great way to start with most patients (other than those with COPD) is with this basic breathing exercise (1992, Lusk):

• Close your eyes…Focus your mind on your breath…Just follow the air as it goes in…and as it goes out.

• Feel it as it comes in…and as it goes out…If your mind begins to wander, just bring it back to your breath.

• Feel your stomach rise…your ribs expand…and your collar-bone rise…Breathe in naturally and slowly.

• On your next exhalation, release all the air from your lungs without straining…Let it all go…Let it all out…Prepare your lungs to receive fresh oxygen.

• Now take in a full, deep breath and let the air go to the bottom of your lungs…Feel your stomach rise…your chest expand, and the collar-bone area fill.

• Now empty your lungs from top to bottom…Let all the air out…Compress your stomach to squeeze out all the stale air and carbon dioxide. Squeeze out every bit of air…Let it all go.

• Take in another deep breath…As you breathe in, your diaphragm expands and massages all the internal organs in the abdominal area…aiding your digestion.

• Breathe out…Relax…Feel the knots in your stomach untie…Let go.

• Breathe in…Your diaphragm is stimulating your vagus nerve, slowing down the beating of your heart…relaxing you.

• Breathe out…Let it all go…relax…relax more and more…Breeathing heals you…calms you…soothes you.

• Breathe in again, fully and completely. Oxygen is entering your blood stream, nourishing all your organs and cells…protecting you.

• Breathe out…Release all the poisons and toxins with your breath. Your breath is cleansing you…healing you.

• Breathe in.

• Now imagine exhaling confusion…and inhaling clarity.

• Imagine exhaling darkness…and inhaling light.

• Imagine exhaling hatred…and inhaling love.

• Exhaling anxiety… and inhaling peace.

• Exhaling selfishness…and inhaling generosity.

• Exhaling guild…and inhaling forgiveness.

• Exhaling weakness…and inhaling courage.

• Breathe in through your nose and sigh out through your mouth. Let the air stay out of your lungs as long as it is comfortable, and then take another breath.

• Let your breath return to its normal and natural pace. Continue to breathe in slowly, smoothly, and deeply…Your breathing is steady, easy, silent.

• Each time you exhale…allow yourself to feel peaceful…calm…and completely relaxed…If your mind wanders, bring your attention back to your breath.

· Stretch and open your eyes, feeling refreshed, rejuvenated and alert.

Another good way to start relaxation training is with a body scan like this (1992, Lusk):

• Begin taking deep breaths. With every inhalation, fill your body with positive energy…With every exhalation, feel all of the negative energy being released from your body.

• Continue to breathe deeply, focusing on bringing in the positive energy as you breathe in, and letting go of the negative energy as your breath is released.

• Now focus your attention on your body, all the different parts of your body…You will begin to do a “body check” that will bring you in touch with your physical body and create and awareness of your body parts.

• First focus on your feet and legs…Breathe in positive energy to your feel and legs, and breathe out negative thoughts and energy.

• Now focus on your thighs and hips…breathe in positive energy to your thighs and hips, and breathe out negative thoughts and energy.

• Move up your body and focus on your buttocks and abdomen. Breathe in positive energy to your buttocks and abdomen, and breathing out negative thoughts and energy.

• Now bring your focus to your upper and lower arms and hands. Breathe in positive energy to your neck, head, and hair… Breathe out negative thoughts and feelings.

• Focus on your face, and particularly your eyes, nose, and mouth…Breathe in positive energy to these areas and breathe out negative thoughts and feelings.

• How do you feel about your feet, calves, and upper legs? Do they feel heavy and sluggish?…tense?…or maybe light and relaxed?…Get in touch with the feelings you have towards your fet, calves, and upper legs.

• Move your concentration up to your hips and buttocks, and again, get in touch with the feelings you have for your buttocks and hips. Do they feel heavy and fat?…perhaps strong and smooth?

• Draw your attention on up to you abdominal area…then to your chest…and upper back…Now to your shoulders, arms, neck, and head…How do these areas of your body feel to you?

• Once you have taken enough time to do a body check and have thought about how you are feeling, begin again. But this time repeat silently after me a positive affirmation for each body part and for each area of your body. If your mind begins to wander or if you deny or doubt the affirmation, acknowledge your discomfort to yourself and then bring you attention back to the affirmation and repeat it silently and as confidently as you can.
• As you continue to practice positive self-talk through affirmations, you will begin to see a shift in your mindset and begin to create positive, healthy body affirmations that become a regular part of your psyche.

• My feet are a wonderful support for my body…I take care of them and respond to their needs.

• Repeat this affirmation silently to yourself to give participants time to say the affirmation silently to themselves. Repeat this for each affirmation.

• My calves, knees, and thighs are strong and beautiful and give me sound support for the rest of my body… They are just right the way they are…My legs take me where I want to go…I move with coordination, grace and ease…My legs are just right for who I am.

• My hips and buttocks are smooth and strong…I take care of them and respond to their needs…I take care of them and respond to their needs…I take care of my hips and buttocks by exercising and eating well…My hips and buttocks are just right for me right now.

• My back is healthy, strong yet flexible…My spine give me all the support I need, and it feels good, strong, and healthy.

• My stomach and chest are just right for who I am…My stomach and chest are a positive expression of my health and well-being…My digestive system digests my food and nourishes my body…My heart is strong and beats in perfect rhythm.

• My shoulders, arms, and hands suit my needs just the way they are…My arms are strong…My hands express my talents to their fullest…They allow me to touch others in my special and unique way…They allow me to be touched by others in a positive way.

• My neck support my head and my head is perfectly balanced upon neck and shoulders…My hair is healthy and strong…My eyes see clearly and sparkle with my inner beauty…My nose allows me to breathe deeply and energizes my body with each breath…My ears hear clearly and allow me to appreciate the sounds of life…My mind is sharp and my thoughts are positive.

• My attitudes and perceptions about myself are positive…I honor my body and make choices that are healthy and respectful of myself…Every day in every way, I am better and better…I continue to create a health centered approach to living that nurtures every part of me.

• Continue to bathe yourself with positive affirmations, personalizing each thought to your own needs.

• Pause for 1 minute

• Now bring your attention back to your whole body…Let y9ur attention sweep up from your feet to your torso and shoulders and down your arms, over to your hips and up your back to your neck, head, and face. Breathe fully and deeply once again. On the inhalation, bring positive energies into your body. On the exhalation, feel the positive energies spreading throughout your entire being.

• Let your breath return to normal. Silently count from 5 to 1, stretch and then open your eyes. 5…4…3…2…1…Stretch and then open your eyes.

Autogenic Training is a form of relaxation developed in Europe and which uses phrases the patient says to themselves related to sensations like heaviness as part of the script (1992, Lusk):

• Prepare yourself to relax now. Prepare yourself to experience calm…to feel quiet…to know peace. Find a comfortable position…Begin to sink down…and be supported by your surrounding environment.

• Close your eyes now…and focus on breathing naturally. Inhale…and fill yourself with life-giving air. Exhale…and relax…allowing your body to sink…breathing in…and breathing out.

• Begin to withdraw your thoughts from your surroundings…and to center your focus inward on the peace…and the stillness…within you. Prepare yourself with an attitude of passive attention…alert but quiet…aware…yet at peace.

• And…making nothing happen…you let of the tension of controlling anything…you watch the relaxation you feel spread to all parts of your being.

• And you breathe in…easily…and breathe out naturally. Part of the rhythm…of all life.

• And you focus on your breathing. As you breathe in…you say to yourself…”I am.” As you breathe out…you say to yourself…”relaxed.”

• I am…relaxed.

• I am…relaxed.

• I am…relaxed.

• I am…calm.

• I am…comfortable.

• I am…relaxed.

• I am…relaxing…into the supports around me. My mind is quiet. My whole body is relaxed.

• I am…at peace.

• I notice…my quiet.

• I notice…my peace.

• I notice…my calm.

• I think about my right hand…I allow my right hand to become heavy with my breathing…My right hand is becoming heavy…My right hand is heavy…and relaxed.

• I allow the heaviness of my hand to spread up my arm…I think about my right arm…I allow my right arm to become heavy with my breathing. My right arm is becoming heavy…My right arm is heavy…and relaxed. My right hand and arm are heavy and relaxed.

• I think about my left hand…I allow my left hand to become heavy with my breathing…My left hand is becoming heavy…My left hand is heavy…and relaxed.

• I allow the heaviness of my hand to spread up my left arm…I think about my left arm…I allow my left arm to become heavy with my breathing…My left arm is becoming heavy…My left arm is heavy and relaxed.

• My left hand and arm are heavy and relaxed. I think about both of my hands and arms…I allow both hands and arms to become relaxed…and heavy…with my breathing.

• My hands and arms are heavy. My hands and arms are heavy and relaxed. I continue to breathe deeply…rhythmically.

• I allow the heaviness of my hands and arms…to spread down my back to my right leg and foot…I feel the weight of my body…and my back. My hands are warm and heavy…My back is relaxed. My legs and feet are becoming heavy.

• Pause

• I think about my right foot…I allow my right foot to become heavy with my breathing…My right foot is becoming heavy…My right foot is heavy…and relaxed.

• I allow the heaviness to spread to my leg…I think about my right leg…I allow my right leg to become heavy with my breathing…My right leg is becoming heavy…My right leg is heavy…and relaxed.

• My right foot and leg are heavy and relaxed.

• I allow the heaviness of my foot and leg…to spread across my hips…and down my left leg to my left foot.

• I think about my left foot…I allow my left foot to become heavy with my breathing…My left foot is heavy…and relaxed.

• I allow this heaviness to spread to my leg…I think about my left leg…I allow my left leg to become heavy with my breathing…My left leg is becoming heavy…My left leg is heavy…and relaxed.

• I think about my feet and legs…I allow both feet and legs to become relaxed and heavy…My feet and my legs are becoming heavy…My feet and my legs are heavy…and relaxed.

• I imagine tiny weights attached to my arms and legs…making my arms and legs heavy…gently pulling my arms and legs down…My arms and legs are sinking…relaxing.

• Both of my legs are heavy. Both of my arms are heavy.

• My hands and my arms are heavy…and relaxed. My feet and my legs are heavy…and relaxed.

• My hands and arms…feet and legs…are heavy…and relaxed.

• I am comfortable.

• I am…quiet.

• I am…at ease.

• My body is in tune with my mind…and connected by my breathing.

• I am…heavy.

• I am…relaxed.

• I am…quiet.

• I feel the energy flowing…through my arms to my hands…through my legs to me feet.

• I am alive.

• I am refreshed.

• I am relaxed.

• I feel a freshness of spirit.

• Pause

• Continue with a visualization exercise or say the following:

• Now prepare to open your eyes. Take a deep breath…and open your eyes…slowly…while you remain fully relaxed.

• Now gently stretch…but remain relaxed. Begin preparing yourself to return to your world…relaxed…and refreshed.

• Your eyes are open…You are aware of your surroundings…but you remain relaxed…and calm. You prepare to move on…with you as you move on with your day.

Introducing a visualization like the following can deepen relaxation (1992, Lusk) :

• Take in a long, deep breath…Hold it…Now slowly and completely exhale. Allow your jaw and shoulders to drop as you exhale.

• Visualize the following, allowing your mind to roam freely in its own way.

• Imagine you are on vacation. No cares, no worries. You feel completely free from your usual daily pressures and hassles.

• You are walking along the water’s edge on a quiet, secluded, warm ocean beach…You are dressed comfortably and are either alone or with someone close to you, whichever you prefer. As you stroll along the water’s edge, you feel the coolness of the damp sand under your feet…and hear the gentle rolling of the waves…Under your arm you carry a rolled up towel.

• You turn away from the water and look at the soft, white warm sand. You pick a spot where you can be alone and still…You put down your towel, and using it as a pillow, you lie down on the soft, pleasantly warm sand.

• You feel the warmth of the and on your back, your legs, and your arms.

• You notice the deep blue of the late morning sky. It is completely clear, except for one wispy cloud near the horizon over the water.

• You feel the gentle warmth of the sand beneath…You feel utterly relaxed and still. For the next several minutes, continue to experience this place, allowing your mind to wander as it wishes. Enjoy this very pleasant sensation of stillness, warmth, and quiet.

• Pause for 2 minutes

• And now imagine getting up…gathering up your towel…walking back to the water’s edge. Again, you experience the cool, damp, sand underfoot…You continue on along the beach, feeling alert, refreshed, peaceful, and renewed. You give yourself credit for this positive experience.

• Now bring your attention back to the present. Draw a deep breath. Open your eyes.

Or try these elements (1992, Lusk):

• Make yourself as comfortable as possible. Close your eyes and become aware of which parts of your body are feeling tense and which parts are relaxed.

• Now take a few deep breaths, taking the air in through your nose, holding it momentarily…and then slowly exhaling through your nose…And with each exhale, you will find yourself relaxing more and more deeply, more and more completely.

• Take the air in and let the air out. Allowing yourself to relax…relax…relax.

• In a few moments, I am going to describe a very vivid scene in which you will picture yourself walking along a beach. I want you to imagine this scene as though you ar there experiencing not only the sights, but the sounds, smells, tastes, and touches.

• It is a bright summer day. It is late in the day. You decide to go for a walk along the beach. The sun is radiating warmth and comfort as it shine boldly. The sky is crystal clear without a cloud in sight. The grains of sand beneath your feet shine from the sunlight and warm the soles of your feet. The sound of the waves beating against the shore echoes in the air.

• You feel the warm, light breeze brush against your face as you walk onward. Far off in the distance, you can hear the cries of sea gulls…You watch them glide through the sky, swoop down into the sea, and then fly off once again.

• As you walk further along the shore, you decide to rest. You sit down on a mound of pure white sand and gaze out at the sea, staring intently at the rhythmic, methodical motion of the waves rolling into the shore.

• Each wave breaks against the coast…rises slowly upward along the each, leaving an aura of white foam, and then slowly retreats back out to sea, only to be replaced by another wave that crashes against the shore…works its way up the beach…then slowly retreats back out to sea.

• With each motion of the wave as it glides in and as it glides out, you find yourself feeling more and more relaxed, more and more calm…more and more serene.

• The waves are gliding in…and the waves are gliding out…You feel more and more calm…Continue to watch the waves glide in…and out.

• Now, as you stare off into the distance, you see that the sun is beginning to sink into the horizon. The sun is sinking down and you feel more and more relaxed as you see its movement going down…down…down.

• The sky is turning brilliant colors of red…orange…yellow…green…blue…and purple…As the sun sets, sinking down…down…down…into the horizon, you feel very relaxed and soothed. You watch the sun as it sinks down…down…down.

• The beating of the waves, the smell and taste of the sea, the salt, the cries of the gulls, the warmth against your body—all these sights, sounds, and smells leave you feeling very soothed, very calm, very serene.

• Relax…relax…relax.

• Pause

• In a few moments, I will count from one to three. When I reach the count of three, your eyes will open and you will feel completely refreshed and totally relaxed.

• 1…2…3.

Type A Behavior and Anger

Type A people are described as competitive, goal-oriented, productive, ambitious, leaders in the making who are in a hurry. They are competent and determined to be successful—and frequently are. The problem is that they are also likely to be hostile and angry.

The specific aspects of a Type A individual that continue to be related to heart disease are explosive reactions, competitiveness, impatience, irritability and hostility. Lumped together these traits equal anger.

It is the tendency to be angry and hostile that results in the Type A paradox: the anger that drove you to triumph over all obstacles to reach professional heights is the same behavior that puts you at risk for serious illness and death. Closer examination suggests that the crux of the matter is motivation. Type As seek excellence to prove their worth. Type B people, on the other hand, can also achieve personal success but do so because the process is enjoyable to them. Type Bs feel secure inside and do not need hostility or competition to succeed.

While discussions about adrenaline and noradrenaline—two of the stress hormones associated with the sympathetic nervous system (SNS); its opposite, the parasympathetic nervous system (PNS) is less frequently discussed. This is unfortunate since the parasympathetic nervous system is vital for survival. When activated the parasympathetic nervous system released a compound called acetylcholine to any tissues served. Once inside of a cell acetylcholine has the ability to neutralize adrenaline. Most organs involved in the fight or flight response receive input from both the sympathetic and parasympathetic nervous systems. The PNS can put the brakes on the fight or flight physiological changes. It cools us down and calms us. It puts the brakes on anger.

In a series of studies carried out in Japan it was discovered that Type A men, especially those with high hostility levels, have weaker parasympathetic nervous systems than men with low hostility levels. An effective PNS can help counter the effects of the SNS which results in the heart working less hard and lowering the risk for developing heart disease.

There is also research that indicates that the immune system may be weaker in hostile people. The immune system is thought to play an important role in helping keep us cancer free, especially in the action of “natural killer cells” which can kill tumor cells that form in the body. A study involving low and high hostility scoring med students indicated a reduction in the natural killer cells in the blood of high hostility students during high-stress exam periods.

In summary, hostile Type A people are wired differently. Their SNS is activated at the slightest provocation while nonhostile people’s SNS show relatively small responses to even strong stimuli. The end result is that hostile people spend more time under the influence of an aroused nervous system which can set the stage for the development of heart disease because of repeated exposure to elevated cardiac demands, increased mobilization of cholesterol into the blood, and increased clumping of platelets while the immune system functions are decreased. This difference in exposure may account for the increased death rates seen in aggressive Type A individuals.

Heart disease

If your immediate impulse when faced with having to wait in traffic or in a long line at the grocery checkout, or dealing with a recalcitrant computer is to start blaming people, and getting angry you are slowly killing yourself. Your anger has turned into hostility and you are at increased risk from death from many causes.

Research indicates that high hostility levels in older men are strongly related to the development of heart disease. Hostility appears to be a greater risk factor than high cholesterol levels, smoking, and being overweight. Furthermore the older men in this study with the highest levels of hostility were at the greatest risk of developing heart disease. This increase in risk appeared to be independent of insulin levels, body mass index, waist-to-hip ratio, triglyceride levels and blood pressure. In other words, being highly hostile appeared to be more closely related to the development of heart disease than the more commonly thought of risk factors and the higher the hostility level the greater the likelihood of developing heart disease.

Constant chronic feelings of anger, hostility and aggression raise the risk of developing arteriosclerosis and coronary heart disease as much as five times the normal rate. Suppressing anger is not a major contributor to heart disease; over-experiencing and over-expressing anger is the villain.

Hypertension

Research has indicated that anger causes high blood pressure in hostile people in much the way salt increases blood pressure in people who already have high blood pressure.

Anger is a poison for hostile people. In a research study that examined the effect of harassment on men trying to perform a mental test, ONLY highly hostile men showed increases in blood pressure and blood flow to the muscles. Men who scored low on the hostility scale did not demonstrate these physiological changes. The high hostility group also reported much higher levels of anger and irritation afterward than the less hostile men. In a second study the high hostility men were shown to also have a larger increase in stress hormones than the less hostile men. This closer connection between anger and physiological hyperactivity can be one of the explanations why hostile people have more health problems. Hostile people need to control their anger if they want to avoid increasing their risk for health problems.

Social costs of anger

It is no fun being around someone who is constantly angry. Hostile, angry people are not happy. Not only do hostilely angry people hurt their spouses but they also hurt their children. While they may not resort to physical violence, verbal abuse is common and extremely detrimental to the children. If nothing else anger can reduce the intimacy in personal relationships as your partner and other family members become more guarded in their interactions with you.

Hostile individuals also report more stress in the interpersonal aspects of work. They are less satisfied with their jobs and have a negative view of work relationships. In addition, an aggressive interpersonal style sabotages the goodwill of subordinates and lowers the probability of work goals being met. Colleagues begin to avoid the hostile employee resulting in the chronically angry individual feeling isolated.

Many hostile people blame everyone else for their social problems. This is unfortunate because lack of a social support system is one of the paths a hostile person can take to serious disease. Angry people frequently have cynical attitudes toward others and are unable to recognize or utilize support when it is available; especially if the offers for help are judged inferior because of their overly demanding expectations. When genuine attempts to help are shunned or ridiculed it only worsens the situation, pushing others further and further away.

Finally, angry people tend to drink, smoke and eat more than their less angry counterparts. Without a social network of people to dampen these tendencies the probability of serious health consequences seems inevitable.

Optimists Are Healthier

Over the past two decades research from around the world has produced a steady stream of scientific evidence that psychological traits, especially optimism can contribute to good health. Optimism does this by:

• Reducing that sense of helplessness that stifles constructive action.

• Giving a person a reason to stick to health regimens and seek medical advice

• Reducing the number of bad events a person experiences because optimists are more likely to take steps to stop bad events once they begin

• Fostering social support, which is important because close friendships reduce the risk for disease, particularly the recurrence of chronic disorders

How is this possible? States of mind, such as hope, can affect the rest of the body. When a person is depressed, catecholamines, one type of neurotransmitter, become depleted. When catecholamines get depleted, the brain’s internal morphine( i.e., chemicals called endorphins) increase. When the level of endorphins increases the immune system detects this and turns itself down. This reduction in the immune system is temporary in grieving people. On the other hand, a pessimistic outlook on tends to lower immune activity independent of physical health problem and transient emotional states. Unlike temporary states such as sadness during a bereavement, or depression in the course of a divorce, or a bout of illness, pessimism may be able to impair your health over the course of your entire life span.

Traditional views do not acknowledge a major determinant of health, namely our own thoughts. The reality is that we have much more control than we probably think we do. For example:

• How we think, especially about our health, can change our health.
• Optimists catch fewer contagious disease than pessimists
• Optimists are more motivated to maintain better health habits than pessimists
• The immune system of an optimistic individual works better than the immune system of a pessimistic individual
• There is even evidence that optimists live longer than pessimists.

One of the most intriguing studies in this area has been going on for decades. In the mid-1930’s the William T. Grant Foundation decided to study healthy men throughout the course of their adult lives. The investigators were interested in studying exceptionally gifted people to learn more about what determines success and good health. Subjects were selected from five Harvard freshman classes. Investigators selected men who were physically fit and intellectually and socially gifted. This group of men cooperated fully with this demanding study. Participants have received physical checkups every five years, were interviewed periodically and had to fill out endless questionnaires. Their diligence has provided a treasure of information about what makes a person healthy and successful.

As time passed and the original investigators aged they decided to ask a younger man, George Vaillant, a brilliant young researcher, to assume responsibility for the continuation of this longitudinal study. George Vaillant’s first important finding from the study was that wealth at age twenty does not guarantee either success or good health. Instead he found a high level of failure and poor health among the men in the study including failed marriages, bankruptcies, premature heart attacks, alcoholism, and suicide. Indeed these men experienced tragedy at almost the same rate as men born at the same time in the the poorest areas of the inner city.

The original research challenge had been to try to determine factors predictive of success and good health. So what was going on? If wealth did not guarantee good health and success what did? Vaillant began to focus in on how men in the study dealt with challenging events in their lives. Information that had been collected from the men indicated that even while in college some of them handled bad events with what may be described as “mature defenses.” They used humor, altruism, future-mindedness and the ability to delay gratification to meet the challenges thrown at them. Interestingly some of the men never used these strategies. Instead they used “immature defenses” such as denial, and projection, i.e., blaming others for their problems. By the time they were sixty years old none of the men who used mature defenses in their early twenties was chronically ill. On the other hand over one-third of the men without mature defenses at age twenty were in poor health by the time they were sixty.

About the time the men in the study were entering middle-age, around age forty-five, a study involving 99 randomly selected men from the ongoing study was conducted. The men’s identities and state of health were kept from a second set of investigators that were given essays the men wrote as they returned from service in the World War II in 1945-1946. The essays were compiled into an explanatory-style portrait of each man. These explanatory-style summaries were then returned to the original investigators so they could determine what had happened to these men and whether the second investigators’ designation of individuals as having an optimistic or pessimistic outlook on life made a difference. What was discovered is that the health of the men at age sixty was strongly related to optimism at age twenty-five. The pessimistic men came down with diseases of middle-age earlier than the optimistic men and by age forty-five the difference in health was large. In fact optimism stood out as a primary determinant of health beginning at age forty-five and continuing for the next twenty years. In the next decade researchers will be able to learn if optimism predicts a longer life in addition to predicting a healthier one. While we all cannot be born wealthy, we can modify our outlook on life—especially if taking a more optimistic view leads to better health.

Obesity Epidemic

Obesity is epidemic in the United States. The number of overweight and obese Americans has grown at a disturbing rate, especially over the past few years. Today more Americans are overweight than are normal weight. Over sixty percent of the population is now considered to be overweight, with over 30 percent of the population considered to be obese. This is tragic for America. A very large (and growing) percentage of our citizens are at increased risk for developing serious chronic diseases, and face the prospect of early death. Meanwhile the entire society struggles under the burden of the resulting increase in health care costs.

While genetics plays a role in the predisposition to obesity, the actual development of obesity is strongly influenced by environmental factors, most notably a sedentary lifestyle. Exercise is essential in weight management. For example, if an extra 100 calories a day is consumed above that needed by the body, in one year that will result in a ten pound weight gain. This is particularly tragic since a 20 minute walk is sufficient to burn those extra calories for many people! There are a number of web sites that allow a visitor free access to calculations on how many calories an individual would burn doing various activities based on weight http://www.realage.com/racafe/exest.aspx is one such site. Pick a favorite food, snack, whatever and see the energy cost of that item for you. It is quite illuminating!

Portion size is a large part of the problem. As our lives have become increasingly busy, more and more Americans have turned to restaurant food, sit down or take out, for many of their meals. In an effort to attract customers many establishments began to offer larger portions of high-calorie food at inexpensive prices. Ever fond of a bargain, Americans have been quick to take advantage of these supersized portions. Since people tend to eat more if given more in a portion, calorie consumption has significantly increased. In time the larger portions have come to be considered normal and expected. Thus the amount of food we eat has increased during the same time period that more and more people have become sedentary. Weight gain has been the result.

Risks of obesity include: coronary artery disease (CAD), heart attack, heart failure, angina, abnormal heartbeat, high blood pressure, elevated cholesterol and triglycerides levels, lowered beneficial HDL cholesterol levels, stroke, type 2 diabetes, and certain cancers such as prostate, gallbladder, colorectal, breast, endometrial and kidney. In addition, obesity increases the risk of developing gallstones (in women), liver problems such as an enlarged liver, cirrhosis, or a fatty liver, gastroesophageal reflux disease (GERD), sleep apnea, asthma, shallow breathing (Pickwickian syndrome) which can lead to heart disease, and arthritis. Obesity also increases the risk of reproductive problems such as irregular periods, an increased risk of birth defects, especially neural tube defects, and an increased risk of death of the mother and baby.

The risk of developing type 2 diabetes increases as a person gets heavier. This is very unfortunate as diabetes is a major risk factor for the development of heart disease. While obese individuals are more at risk for arthritis than normal weight individuals, each additional few pounds of weight gain increases the risk for developing this potentially debilitating condition. Finally, recent research suggests that being obese can increase the risk of lowered mental ability, especially in memory and learning, in men over time.

The location of body fat is also important in assessing risk. If the fat accumulates disproportionably around the abdomen, it is an independent predictor of increased risk and morbidity. Thus individuals whose fat accumulates around the abdomen are at greater risk than individuals whose fat accumulates around the hips and thighs. A man with a waist measurement of more than 40 inches or a woman with a waist measurement greater than 35 inches is considered at increased risk for type 2 diabetes, high blood pressure, high cholesterol, and coronary artery disease than normal weight individuals or those whose fat accumulates around the hips.

Importance of Control

Ellen Langer is one of the pioneers in the study of perceived control. Some of her most important findings come from field experiments with collaborator Judith Rodin which were conducted in nursing homes for the elderly. These studies pointed out the significant physical and mental gains that can be achieved in elderly people in institutional settings if they are given a sense that they are at least partially in control of their own lives by being able to choose some of their daily activities. Research has shown that perceived control is crucial not only for one’s psychological well-being but also for one’s physical health. Furthermore there is evidence that believing that one has control may be even more important than actually being able to make the overt responses to cause the desired outcome.

Langer’s theory suggests that conditions that allow people in situations governed by chance to behave as if skills count, benefit from an illusion of control. Skill-related behaviors such as: making choices, thinking about the task and possible strategies to be use, exerting effort while working on the task, learning about the materials and responses to be made, and competing with other people to evaluate ability, reduce a sense of helplessness. This perception gives individuals in a chance situation, in which they have no objective influence on outcome, an illusion of control. In this situation people became motivated to master their environment and to avoid the negative consequences of feeling like they are not in control. They perceive the simultaneous occurrence of chance and skill elements as clouding the difference between the two; and that their behavior is not “irrational” rather it is viewed as a possible opportunity for gain. People tend to make judgments about the causes of events and see themselves as having the ability to determine what will happen if an outcome is positive, even as they ignore the objective reality that they are overestimating the probability of success.

In short, people need to believe that they have some control over what happens to them. While there may be millions of losers in every big lottery, there are also winners. And there really are exceptional people, like the young mountain climber who amputated his own arm to free himself when a boulder imprisoned his arm in an accident. He climbed down a steep incline and walked six miles to safety when he surely would have died otherwise. There are also people like Lance Armstrong who overcame cancer and became the first person to ever win the grueling Tour de France bicycle race six times. There really are heroes. We need to believe that we too can beat the odds and overcome enormous obstacles that would crush lesser mortals. That mountain climber and Lance Armstrong believed they could control events when others might not do so.

According to Langer and her colleagues there are two kinds of control:

Primary control involves changing a situation. Owning our behavior and becoming more resilient requires that we realize that we are the authors of our lives. Instead of always trying to change everyone else we should ask what is it that I can do to change the situation? It is not just the elderly in nursing homes who benefit from feeling like they have some control of their daily activities, it is us all. Research supports the importance of personal control as a major factor in our physical and emotional well-being. A sense of control fosters optimism and optimism can be protective. Primary control means changing the situation.

Secondary control involves how we view a situation. Even in situations that we cannot directly change we can determine how we think about it. Even when faced with major life challenges like serious illness, death of a loved one, divorce, loss of employment and natural disasters a lot of what happens to us emotionally and physically is determined by how we look at the situation. Secondary control means changing the way we view the situation and how we feel about it.

Diabetes is a Killer

Diabetes mellitus is a heterogeneous group of disorders characterized by high blood glucose levels (hyperglycemia). The World Health Organization has defined four major types: Type 1 Diabetes, Type 2 Diabetes, Gestational Diabetes and Diabetes secondary to other conditions. Type I is associated with low (or absent) levels of insulin, develops in childhood and requires daily insulin injections for survival. Type II usually develops in persons over 40 years of age and can be managed with lifestyle changes and oral medication.

Diabetes mellitus is a chronic, incurable disorder of carbohydrate metabolism. It involves an imbalance of the supply and demand for insulin. Food ingested is eventually converted to glucose (sugar) when it is carried in the blood to nourish all cells of the body. In diabetes mellitus insufficient insulin is available to meet this need because of:

(1) Failure of the islets of Langerhans to produce enough insulin

(2) The destruction of the insulin before it can be used, or

(3) Inability of body tissues to use the insulin

When cells are unable to use glucose large amounts accumulate in the blood and the condition called hyperglycemia results. Due to the concentration of glucose the kidneys excrete large amounts of water and the patient wants to drink large amounts of water. In addition, a loss of energy derived from food which is eaten results in compensation by increasing food intake. The body metabolizes its own store of fat and protein and a substance called ketones is produced. A toxic level of ketones can cause a condition called ketosis which can cause a coma.

Type I or insulin-dependent diabetes is the most severe form of this disease. Insulin is the essential therapy and it must be injected into the subcutaneous, fatty layer of tissues. The goal of insulin therapy is to maintain the blood sugar levels as close to the normal range as possible. To avoid frequent injections some patients use an insulin pup which provides a slow, continuous subcutaneous infusion of insulin throughout the day.

In Type II or non-insulin dependent diabetes the body produces insulin but not enough to meet the body’s total needs. Insulin is not required and treatment includes dietary management, exercise, and medication that helps the body make better use of the available insulin.

Diabetic diets are individualized based on such factors as age, weight and daily activity level. Adherence to the diet is essential. Exercise is also essential but must be coordinated with the use of insulin in Type I diabetics.

Diabetic coma occurs when there is too much circulating glucose in the blood. The onset may be gradual. Few symptoms may be evident until levels become severely elevated. Individuals may become confused, drowsy, have difficulty breathing, nausea, vomiting and flushing of the skin. Diabetic coma is a medical emergency that can result in death without treatment.

Insulin shock is the opposite of diabetic coma, occurring when there is too much insulin in the blood. It may result from injecting too much insulin or from an unusual amount of exercise that burns up glucose normally available. Individuals may feel weak, hungry and nervous. They patient may perspire although the skin is cold to the touch. Confusion and personality changes may occur. If not treated the patient may become unconscious and brain damage and eventually death may occur.

Complications from diabetes can affect a number of body systems and result in major disability. Vascular changes can contribute to myocardial infarction or cerebrovascular accident. Circulation problems can result in peripheral vascular insufficiency so that even minor injuries are prone to become so severely infected that amputation becomes necessary. Deprivation of blood supply to the kidney can result in kidney failures. There can also be changes in the nervous system and changes in the peripheral nerves that result in loss of sensation and pain sensations.

In Type 2 diabetes lifestyle changes can be of great value and the psychologist’s knowledge of motivation and adherence can be of great help. The key to self-regulation in diabetes is testing blood sugar each day and for optimal effect more than once a day. Self-testing is rare in Long Term Care but it remains important that the patient be engaged and keeps track of levels even if the nurse does the testing.

One service that the Primary Care Psychologist should provide is Motivational Interviewing to promote (e.g. especially for Type I). Behavioral strategies aimed at enhancing motivation and self-regulation have been shown of great value. Also, hypoglycemia can be very frightening and many patients remain hyperglycemic as an avoidance strategy. The psychologist’s knowledge of fear and the management of fear can be of value.

Stress coping and affective regulation are important in management of diabetes. Depression has been shown to lead to failure of adherence to the medical regimen. Improved ability to manage stress has been shown to enhance the management of the disease. A well designed personalized program for better management of stress can result in:

• Improved psychological well-being
• Improved blood glucose control and thus reduced risk of complication
• Reduced insulin regulation
• Fewer emergency episodes.

Communication Skills

Many people have trouble expressing their feelings. It may be because they do not feel entitled to do so or they don’t really know how they feel. Most often they just don’t know this simple formula:

· I feel.

· When you.

· Because.

All three elements must be included. It is important that you finish the “I feel” with how you feel but without being aggressive. For example “I feel you are a jerk” is aggressive not assertive. When you are effectively assertive you are explaining how you feel when certain things happen and why. Instead of “I feel you are a jerk,” how about, “I feel like you don’t think much of me when you know you will be late for dinner and don’t take the time to call because I don’t know what is keeping you and I worry.”

The most common times when people have trouble being angry rather than assertive are:

· Stating a difference of opinion

· Receiving and expressing negative feelings

· Dealing with someone who refuses to cooperate

· Speaking up about something that annoys you

· Protesting a rip-off

· Saying “No”

· Responding to undeserved criticism

· Asking for cooperation

· Proposing an idea

One of the first elements in assertiveness is to learn to stop and reflect before responding. The sequence should be:

· Immediate stop (think of a big red stop sign)

· Breathe and use a relaxing cue (e.g. like the word calm or cool )

· Reflect and look for your emotional trigger

- Am I responding to a real problem on my own distorted thinking?

- Do I need to “win” in this conversation?

- Am I afraid to show any sign of weakness?

- Do I feel compelled to put this person down?

· Choose how you want to respond

· Respond

Even assertive people have trouble under pressure. When under pressure try these steps:

· Make eye contact with the person.

· Don’t go on until you feel relaxed. If you need more time, buy time by saying “okay,” or “all right.”

· If you are still unable to relax, it might be best to temporarily remove yourself from the situation. Disengage with a polite statement, such as “I’m really upset now. I’d like to return in a few minutes and talk with you about what happened.”

· Use “I” statements to express your feelings or make a request. This is to simply let the other person know where you stand, not to give you power leverage.

· Reflect the other person’s response by using “and” statements, not “but.” For example, “I understand you are upset, and when you yell like that, I get very upset.” This kind of response, as opposed to the more negative statement using “but,” creates an air of conciliation and allows for constructive discussion.

· Assess your effect. Did the person hear you? If so, continue. If he or she was too angry to understand, restate or reflect in another way. If it seems that communication is impossible, disengage until another time.

· State your needs and your common goals with the person. This can be difficult when anger and defensiveness rule, but it is vital for creating an empathetic mood. For example, “I would like to see your department as productive as possible and I know you would like us to try your plan. Here is a suggestion I would like to share with you.

Note that if you need to leave the situation to compose yourself, then do. It is better to stay in control.

Anger Can Be Poison

Anger is an emotion that is experienced by all people everywhere. Anger usually results from an emotional hurt. It is typically experienced as an unpleasant feeling that occurs when we feel injured, mistreated, or are opposed in long held views, or are faced with obstacles to attaining personal goals. Anger varies in its frequency, intensity, and duration. People also vary in how easily they get angry, their anger threshold, as well as with their comfort level with the emotion. Some people are always getting angry while others don’t even recognize that they feel angry. While some experts say that the average adult gets angry about once a day and annoyed or peeved around three times a day, those who work with people with anger management issues suggest that getting angry 15 times a day is average. In any case, anger is a common human emotional which we probably experience more often than we would like to admit.

It should be noted that anger can be constructive or destructive. When well managed, anger or annoyance has few detrimental health or interpersonal consequences; when mismanaged anger can be deadly. There is a difference in feeling angry and expressing your anger. To feel anger is to be human. The feeling contains information that can be of value. Expressing your anger inappropriately or prolonging the experience of anger can be dangerous. Not only can out of control anger damage personal relationships, it can lose you your job, land you in jail, damage your health or even kill you. For example, recent research suggests that men who have poor anger management skills are more likely to suffer a heart attack before age 55 than their more mild-mannered peers. A separate study involving 774 older white men (average age 60) indicated that high hostility levels were more predictive of developing coronary heart disease than risk factors like high cholesterol, alcohol intake, cigarette smoking. Older men with the highest levels of hostility were at the greatest risk for developing coronary heart disease independent of the effects of BMI (body mass index), waist-to-hip ratio, fasting blood-sugar levels, triglcyride levels, and blood pressure.

Anger can alienate friends, co-workers and family members. Your expressed anger elicits anger in others as a defense. Hostile, aggressive anger not only increases the risk for an early death but also the risk for social isolation, which is in itself a major risk factor for serious illness and death.

Anger is composed of the thoughts that trigger the emotion, the bodily arousal a person experiences, and whatever behaviors are exhibited, which are often culturally determined. The goal of anger is to protect or further our self-interests, or those of our loved ones, or uphold principles and causes we hold sacred. Instinctively anger often results in the desire to defend ourselves and strike back at its cause, often aggressively. Behind all anger is some form of pain, physical or emotional. It can start with not feeling well or feeling rejected, feeling threatened, or enduring a sense of loss. The type of pain does not matter; the point is that it is unpleasant and it makes you want to end the suffering. It is when these unpleasant feelings are associated with trigger thoughts that anger erupts. Trigger thoughts are assumptions, evaluations or your interpretation of situations that make you feel like you are being victimized or someone is deliberately trying to hurt you.

Many of our trigger thoughts have their roots in childhood. Often a person will overreact to a current situation because they learned earlier in life to be very angry when they experienced hurt, neglect or abuse. As an adult the person will have difficulty with situations and conflicts that threaten them with feeling unworthy, unloved or unsafe. Any time a situation “triggers” these old feelings of betrayal, the anger expressed will not only be about the current irritant but also about remnants of the pain felt before. When one of these old triggers is unleashed the degree of anger expressed is often excessive for the immediate aggravation. In addition if parental role models use anger to manipulate and control family members the children may learn destructive ways to manage anger. The children learn not only to be extremely angry because of the mistreatment they receive, but also how to express their anger in an inappropriately aggressive manner.

Exercise

A sedentary lifestyle substantially increases the risk of certain illnesses. The risk of developing elevated triglycerides and cholesterol levels is increased as is the probability of developing high blood pressure and obesity. These increase the risks for heart disease, diabetes, stroke and some forms of cancer. The brittle bones of osteoporosis are more common in sedentary individuals and conditions such as arthritis may be more debilitating due to the increased stiffness and joint pain associated with inactivity. There is a loss in bodily flexibility and the muscles are not as strong as they need to be to help protect joints and reduce the risk of everyday injuries and accidents. In an inactive person the tendency of the body to lose lean body mass as the years advance is more pronounced than in a physically active individual, as is the associated increase in body fat. Weight gain is almost certain unless caloric intake is significantly reduced, which is highly unlikely in the current environment of large portions and a tendency to eat many high fat, high calorie snacks. A sedentary lifestyle reduces a person’s problem solving ability, speed of thinking, short and long-term memory, reaction time, as well as increasing risk of developing Alzheimer’s disease. Last but certainly not least, an inactive person gives up a major tool for reducing stress as well as a tool for preventing or ameliorating mild forms of depression.

Inactivity robs a person of much of the joie de vivre (joy of living). In addition to increased risk for serious illness, a sedentary lifestyle saps an individual’s energy. A sedentary individual loses muscle mass which leads to a decrease in metabolism and a propensity to gain weight. The brain of a sedentary individual works less efficiently than it would if the same individual were more active. Flexibility and muscle strength are reduced and activities of daily life become more difficult. Everyday stresses become more overwhelming as the body is subjected to frequent bursts of the hormones associated with the fight or flight response without the advantage of the regular exercise (a flight response of sorts) which helps soothe muscle tension, feelings of stress and mild depression. Without regular exercise sleep may be disrupted, eating for emotional reasons may increase, and the use of substances such as drugs or alcohol may also intensify. An individual undergoing these experiences often interprets these changes as a sign of aging even if they are chronologically middle-aged or younger.

The physical changes resulting from inactivity are demoralizing, frustrating and limiting not only to the sedentary individual but also for their family. Inactivity results in a person tiring more easily than if that person was physically active. An inactive individual is more likely to gain weight which often leads to feeling less attractive and less self-confident. It is a chore to make it through daily responsibilities and a couch or comforting snacks or beverages may become the highlight of the day. In fact, many of the liabilities often associated with aging are actually the result of not giving the body opportunities for the activity it needs.

A sedentary lifestyle results in the loss of an opportunity to burn calories, and the loss of lean body mass, which results in a lowered metabolic rate because lean body tissue is more metabolically active. It becomes a major challenge if weight gain is to be prevented. Even an extra hundred calories a day in excess of what the body needs to perform vital functions will result in the gaining of ten pounds in a year. Individuals are born with a certain number of fat cells which is partly determined by their genes. As weight is gained these fat cells expand to their capacity for fat storage. If enough weight is gained, additional fat cells are created by the body. Once the additional fat cells are formed future weight loss will result in the reduction of the size of the fat cells but not in their number. The greater the number of fat cells the harder it is to lose weight and maintain weight losses.

While genetics may predispose an individual to gain weight or affect the speed with which weight may be lost, lifestyle choices play a MAJOR role in what happens to an individual. No, not everyone can (or should) attain the (tall!) slender, toned bodies idealized by the popular media. However, everyone has the choice to be more active. Exercise is essential to weight management.

Relationships and Health

Mother Theresa is said to have been convinced that the greatest of all sorrows was to feel alone, unwanted, and to be without human affection. She saw loneliness to be a greater sorrow than being hungry or homeless or suffering from illness. To be a social being without friends is to be deprived of some of the most valuable of life’s experiences.

The connectedness, seen in resilient adults, involves a mutual give and take in relationships paired with high levels of trust, caring and openness as well as a sense of security and safety. These relationships are not those involving negative qualities like excessive neediness, manipulation, or a lack of empathy and compassion.

Make positive connections a priority in your life. Connections to other people are vital. However, connections may also involve connectedness to causes, towns, schools, religions, jobs, volunteer endeavors, pets, sports teams, etc. In fact, participation in any of these activities allows you to meet people with similar interests.

As in many other areas it is necessary to take charge of your life when it comes to fostering relationships. Do not wait for someone else to make the first move. Reach out in a positive manner to others. While opening oneself up to other people involves a certain degree of risk of getting hurt, not having a social network has far greater consequences.

Throughout our lives our resilience and our connections are enhanced whenever we act to help other people. Connections continuously change. Children are born and grow up, jobs and interests may change.

Resiliency involves the wisdom to modify goals and expectations and to continually improve our ever-changing relationships and connections. The important thing is to be proactive to ensure the maintenance of vital relationships when changes occur. An example is a couple finding special time for the two of them after they have children. Even small gestures such as telephone calls and emails help maintain a certain level of connection.

Self vs. others

Our world grows very small when we focus primarily on ourselves. Not only is our view of the world distorted by not having feed back from other people about errors in our perceptions and thinking, but we also remove ourselves from having the joys of doing things for others. Sometimes we find ourselves alone because of fear that we might be hurt if we let people get too close, or we think we are too busy to waste time on socializing. We may also become self-focused if we feel sad or depressed. A depressed person tends to lose the joie de vivre. Eating and sleeping patterns are disrupted and minor irritations seem like mountains. Activities that are usually enjoyable lose their appeal and most often the saddened person turns away from friends and love ones depriving themselves of social support that might help to alleviate some of their pain. They focus more and more on themselves and the pain they are feeling. It is very easy to see how they can become pessimistic about things getting brighter in the future.

On the other hand, when we are enthusiastically involved with work and home activities, when we cultivate our friendships and nurture many interests, when we take time to show empathy and compassion for other people our emotional life is enriched and we are fortified and made stronger and more resilient.

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Value of empathy

Probably the most important “people skill” of all is empathy. Empathy is the ability to notice subtle verbal and non-verbal signals from other people that let you know what other people feel, i.e., what they need or want. People who do recognize these subtle cues are at a very great social disadvantage personally. On the other hand, people who are empathetic receive both physical and emotional benefits from their concern for others.

Becoming more compassionate

Compassion is vital to strengthening not only our emotional well-being but our physical well-being as well. When a person act with compassion toward other people they experience a “helpers high” with is a type of exhilaration based on both physical and psychological elements. The Dalai Lama in The Art of Living commented that the greater the strength of your compassion the greater your resilience in life when you must confront hardships and the more likely you are to transform challenges into opportunities. Furthermore, the greater your compassion the greater your own courage will become. The more courageous you are the greater your inner strength and your ability to be determined. The greater your determination the more likely you are to be successful in spite of obstacles. In essence, a person’s hope, optimism, resilience and since of self-worth are bound up with their being able to feel connected to others and demonstrating care and concern for other people.

Conflicts at Work

Conflict may be described as a situation in which one person feels that another person has harmed or is about to harm something you care about. Such conflicts may involve incompatibility of goals, differences in interpretation of facts, and disagreements over expectations.

These conflicts can occur at a full range of intensities and levels from more subtle forms of disagreement to violent acts.

The traditional view of conflict, that all conflict in relation to group behavior was bad, prevailed into the 1930s and 1940s. The prevailing solution was to identify the causes of the conflict and correct them to improve group and organizational performance.

More recently conflict is seen as a natural occurrence. Some conflict is inevitable. Proponents say conflict cannot be eliminated and that conflict may even be beneficial in certain circumstances.

Conflict may be either constructive or destructive. Conflict is of three types. They are:

• Task conflict – divergent views as to the task itself
• Relationship conflict –disagreements between people or groups
• Process conflict – differing views on how the work gets done

By its nature low to moderate task conflict can be productive because it encourages the discussion of ideas that can facilitate groups working better together. For process conflict to be productive it must be kept at a low level. It can become counterproductive when turf battles break out, or when it increases the time needed to complete tasks or results in employees working at cross purposes.

Relationship conflicts are almost always dysfunctional because friction and hostilities between people increase the likelihood of personality clashes while decreasing the understanding needed for completion of organizational tasks.

The research literature suggests that within organizations structural factors and individual value differences are greater sources of conflict than communication problems. For example when people work together but pursue different goals conflicts arise. While managers may incorrectly attribute the problem to communication issues further communication efforts only worsen the situation.

The definition of a conflict is important because it delineates a possible set of solutions. Emotions are also important because positive feelings increase the tendency to see possible relationships among elements of a problem and encourage taking a broader view of the situation. Negative emotions tend to result in over simplification of the issues, reduce trust and encourage negative interpretations the behavior of others.

Conflict management techniques include:

• Problem solving – face to face meetings to identify and resolve conflicts
• Superordinating goals – a shared goal is created that cannot be achieved unless both parties cooperate
• Expanding resources – when a conflict is caused by a scarcity of a resource, such as opportunities for advancement, or the potential to make more money, etc., opening up additional opportunities may provide a solution
• Avoidance – pulling out of a conflict or containing a conflict
• Smoothing – emphasizing common interests and minimizing differences
• Compromise – each party is willing to give up something of value
• Authoritative command – management uses its authority to settle the conflict
• Altering human variables – using behavioral change techniques to alter behaviors and attitudes that result in conflict
• Altering structural variables – change the formal organizational structure and interaction patterns for conflicting parties, i.e., transfer employees, redesign jobs, coordinate positions, etc.

Learning to manage conflict can significantly improve resilience to stress at work..

Starting Your Weight Management Program

Here are some key issues in starting your weight management program:

Why are you trying to lose weight? Food is a significant part of our lives. Deciding to make a lifetime commitment to eating better is a big step. You will be most likely to succeed if you are making the change because you have made the decision for yourself and are not merely to please other people.

What worked or did not work during previous attempts to lose weight? There is much to be learned from examining what didn’t work in the past. Do not think of these experiences as “failures” but rather as learning experiences. This is a lifelong journey and modern life makes eating and weight control challenging. You are to be applauded for your courage in deciding to make a change.

Eating is not just a biological necessity it is also an emotional outlet. Think about what triggers you to overeat and develop some alternative behaviors to use when the urge to eat for emotional comfort occurs.

Build yourself a support system of people who care about you and will encourage you in your weight loss efforts. If at all possible avoid people who do NOT want you to succeed for their own personal reasons.

There are no quick fixes. The best diet is a lifetime choice to eat a well balanced diet of healthy foods (and occasional treats) and increase daily activity.

Every time you make a healthy food choice your body benefits. Every bit of increased exercise counts. Even a small weight loss, 10% of your weight, can significantly improve your health.

A healthy weight loss is one or two pounds a week maximum.

Very low calorie diets can be dangerous and the weight loss may be gained back rapidly when the diet ends. Most people can safely lose weight on a low calorie diet, 1200-1500 calories a day for women, 1500-1800 calories a day for men.

Keep in mind that everyone’s metabolism is different. In order to lose a pound you must burn 3500 calories more than you take in. The trick is to find changes that are easy or even enjoyable. For example, it is really easy to substitute diet soda for regular soda, or substitute low or fat-free dairy products for the higher fat variety. Or eat a piece of fruit instead of a bag of chips. If you choose a form of exercise that you enjoy you will find that you will want to stick with it because it makes you feel good and enriches your life.

Diets work because a dieter eats fewer calories than are needed to maintain their current weight. After reviewing diet options and your food diary, you will know more about yourself. If you eat too many high-saturated fatty foods, then reduce the type and amount of these foods. If you overeat for emotional reasons then try and find alternative behaviors. For example, while yoga does not burn huge numbers of calories it can relieve stress. If you practice a few yoga poses when you are upset (perhaps while listening to soothing music) you will often find that you begin to feel better without having to eat half a cheesecake, or a bag of chips or a pint of premium ice cream..

Slowly change your eating habits. Learn what a serving of a food is really supposed to be and begin to measure your food. Serve the food on smaller plates and eat slowly. Eating slowly will allow you to notice at what point you are satisfied—if you gobble down your food you completely eliminate this appreciation and can turn up overeating and feeling uncomfortable.

Try to include more fruits and vegetables in your diet. If you are worried about a glycemic number then pick primarily from fruits and vegetables that have a low glycemic number. Eating foods in combination also decreases the glycemic impact of a single food.

Food diary

A food diary is a notebook in which you record absolutely everything you eat or drink over a period of time. As part of preparation information should be kept for at least three weekdays and a weekend. A lot of people eat differently over the weekend than during the week. The important thing is to be ABSOLUTELY honest. No one else needs to see this notebook but you, but you need to know the truth. In addition to the items and their quantities, be sure and record where you ate the food and how you felt.

Using the scales

During the preparation phase weigh frequently, and settle on a specific time of day for your baseline weight. Early morning, before breakfast, is usually the best time of day to weigh. Be sure and do follow-up weight checks at the same time of day as the baseline weight to keep normal daily weight fluctuations from making you feel like you are not making progress when you really are. Weighing several times a day during the preparation phase allows you to observe your normal body fluctuations during the day. Just drinking a couple glasses of water can make the numbers on the scale go up. After the assessment period weigh only about once a week at the same time as your baseline measure.

BMI

The current “gold standard” for determining a healthy weight is the body mass index (BMI). Body mass index is determined by dividing the weight in kg by the height in meters ². In general a BMI of 30 or over indicative of obesity, while a BMI between 25 and 29 indicates being overweight. BMI is not a reflection on how we look, or a comparison of our weight with one of the media’s idealized slim, toned bodies, it is rather a reflection of the effect excess fat has on your health.

A BMI table and accompanying comments are available as part of the Report of the Dietary Guidelines Advisory Committee on The Dietary Guidelines for Americans (2000). These guidelines may be read on line, printed out in PDF format or ordered at http://www.health.gov/dietaryguidelines/

Circumference measurements

Two important circumference measurements are those of the narrowest point at the waistline and the broadest point at the hip. These two measurements can then be used to determine the waist-to-hip ratio (WTH). The waist measurement is divided by the hip measurement. High WTH ratios are associated with greater health risks. In other words if a person has most of their extra body weight in the hips and legs it is less dangerous for their health than if the fat was stored in the trunk of the body.

A waist circumference of 40 inches in men and 35 inches in women is cause for concern if there are other health problems than being overweight may worsen.

In addition to your waist and hips, it is also helpful to measure thighs, upper arms, chest, neck and anywhere else you are concerned about reducing. Since muscle weighs more than fat the scales may not be completely reliable witnesses to the changes going on during a weight loss/exercise program. A periodic check of circumference measurements may well show a decrease in size even if the scales do not indicate much change. Muscle takes up less space than fat and will often result in your dimensions decreasing even if the scales are not so cooperative.

Body fat measurement

A baseline estimate of your body composition (body fat mass vs. lean body mass) is very informative. Two of the most cost effective ways of estimating body fat are through skinfold caliper measurements or by weighting on a bio-electric impedance scale. Bio-electric impedance analysis is a painless process in which a known current is based through the body. Lean body mass is a good conductor of electricity whereas fatty tissue is not. The scale is able to come up with an estimate between the fat-free mass and total body water and the amount of resistance found by the analyzer.

Skinfold caliper measurements should be made by an experienced medical or fitness professional. Some gyms offer this service; some also have commercial bio-electric impedance scales. Bathroom scales that also provide estimates of body fat via impedance are also available at many retail stores. It is advisable to have skinfold measurements and impedance weight measured taken at the same time of day. You should also have had plenty of fluids to drink and not worked out for 12 hours before the measurements.

Another helpful measurement is wrist circumference or a measurement of the width of the elbow, the space between the opposing bony protrusions on either side of the bent elbow. The elbow measurement is most accurately taken with calipers. These measurements provide ways of estimating the size of your body frame which is part of the calculation in determining just how much you should weigh. A small boned person should weigh less than a big boned person—and likewise it is not realistic for a person with big bones to achieve the weight goals of a smaller boned person of the same height.