Nature-Based Therapies for Sleep Disorders in People Living with Human Immunodeficiency Virus.

Following diagnosis of human immunodeficiency virus (HIV), getting adequate sleep may be the farthest thing from the mind of patients or providers. Even further from mind are the potential benefits on both sleep and HIV from nature-based therapy. In developing and developed countries, access to high-quality natural spaces has the potential to support physical and mental health. This article provides a review of sleep disorders, conventional and nature-based therapies, and the potential of nature-based therapy to support the health of people living with HIV through increased restorative sleep and immune function.

Nature-based supportive care opportunities: a conceptual framework.

OBJECTIVE: Given preliminary evidence for positive health outcomes related to contact with nature for cancer populations, research is warranted to ascertain possible strategies for incorporating nature-based care opportunities into oncology contexts as additional strategies for addressing multidimensional aspects of cancer patients' health and recovery needs. The objective of this study was to consolidate existing research related to nature-based supportive care opportunities and generate a conceptual framework for discerning relevant applications in the supportive care setting. METHODS: Drawing on research investigating nature-based engagement in oncology contexts, a two-step analytic process was used to construct a conceptual framework for guiding nature-based supportive care design and future research. Concept analysis methodology generated new representations of understanding by extracting and synthesising salient concepts. Newly formulated concepts were transposed to findings from related research about patient-reported and healthcare expert-developed recommendations for nature-based supportive care in oncology. RESULTS: Five theoretical concepts (themes) were formulated describing patients' reasons for engaging with nature and the underlying needs these interactions address. These included: connecting with what is genuinely valued, distancing from the cancer experience, meaning-making and reframing the cancer experience, finding comfort and safety, and vital nurturance. Eight shared patient and expert recommendations were compiled, which address the identified needs through nature-based initiatives. Eleven additional patient-reported recommendations attend to beneficial and adverse experiential qualities of patients' nature-based engagement and complete the framework. CONCLUSIONS: The framework outlines salient findings about helpful nature-based supportive care opportunities for ready access by healthcare practitioners, designers, researchers and patients themselves.

Benefits of a Home Treatment Program Using Guided Imagery Relaxation Based on Audio Recordings for People With Fibromyalgia.

Despite the plethora of treatments available for patients with fibromyalgia, there is insufficient evidence to date as to what the ideal treatment approach is. This study sought to determine the effectiveness of a home program of audio-recorded guided imagery relaxation on people with fibromyalgia. This experimental 8-week longitudinal trial design was undertaken with 60 people diagnosed with fibromyalgia who were randomly assigned to either a guided imagery intervention group or a control group. Pain at tender points, anxiety, self-efficacy, quality of sleep, quality of life, and the impact of the fibromyalgia were determined at baseline, at 4 weeks, and at 8 weeks. After the guided imagery intervention, we found significant differences regarding trait anxiety, sleep quality, and tenderness at some of the tender points. There is a need, therefore, to develop and evaluate interventions that may enhance the quality of life of those affected by this disorder.

Physiological changes after spa treatment - a focus on endocrinology.

The paper presents the results of our effort to reveal objective parameters for evaluation of the spa treatment for patients with anxiety-depressive disorders. The study was based on our previous experience with neuroactive steroids and neurosteroids, which play a crucial role in the psychological well-being of patients by maintaining balance of the organism. A total number of 94 steroids were determinated in a group of 70 female patients diagnosed with anxiety-depressive disorders. Patients underwent a month spa treatment while maintaining unchanged medication dosing with SSRI (selective serotonin reuptake inhibitors). The other investigated factors contributing to improving the health of treated subjects were amino-acid homocysteine and serotonin. The blood samples were collected at the beginning and the end of the spa treatment. Serotonin in all patients increased by a relative 23 % (results given as relative differences in percent), while homocysteine decreased by 17.1 %. Statistically significant increases were found in 21 steroids, which indicate activation of the adrenal cortex. It can be assumed, that the overall improvement in the mental condition of patients, which was proved by questionnaire from Knobloch and Hausner, the increase in immune suppressive substances and anti-autoimmune responses, will maintain for a longer time after the spa treatment.

Mecanismos responsables de la relajación neuromuscular en el tracto gastrointestinal / Mechanisms responsible for neuromuscular relaxation in the gastrointestinal tract

El sistema nervioso entérico (SNE) es responsable de la génesis de los patrones motores que aseguran un correcto tránsito intestinal. Las neuronas entéricas se clasifican en aferentes, interneuronas y motoneuronas, que pueden a su vez ser excitatorias, causando contracción, o inhibitorias, provocando la relajación de la musculatura lisa. Los mecanismos de relajación muscular son claves para entender procesos fisiológicos como la relajación de los esfínteres, la acomodación gástrica o la fase descendente del reflejo peristáltico. El óxido nítrico (NO) y el ATP o una purina relacionada son los principales neurotransmisores inhibitorios. Las neuronas nitrérgicas sintetizan NO a partir del enzima nNOS. El NO difunde a través de la membrana celular uniéndose a su receptor, la guanilil ciclasa, y activando posteriormente una serie de mecanismos intracelulares que provocan finalmente una relajación muscular. El ATP actúa como neurotransmisor inhibitorio junto con el NO y el receptor de membrana purinérgico P2Y1 ha sido identificado como elemento clave para entender cómo el ATP relaja la musculatura intestinal. Aunque probablemente ningún clínico duda de la importancia del NO en la fisiopatología motora digestiva, la relevancia de la neurotransmisión purinérgica es aparentemente mucho menor puesto que el ATP no ha sido todavía asociado a una disfunción motora concreta. El objetivo de esta revisión es mostrar el funcionamiento de ambos mecanismos de relajación para poder establecer las bases fisiológicas de posibles disfunciones motoras asociadas a la alteración de la relajación intestinal (AU)

The enteric nervous system (ENS) is responsible for the genesis of motor patterns ensuring an appropriate intestinal transit. Enteric neurons are classified into afferent, interneuron, and motoneuron types, with the latter two being further categorized as excitatory or inhibitory, which cause smooth muscle contraction or inhibition, respectively. Muscle relaxation mechanisms are key for the understanding of physiological processes such as sphincter relaxation, gastric accommodation, or descending peristaltic reflex. Nitric oxide (NO) and ATP or a related purine represent the primary inhibitory neurotransmitters. Nitrergic neurons synthesize NO through nNOS enzyme activity. NO diffuses across the cell membrane to bind its receptor, namely, guanylyl cyclase, and then activates a number of intracellular mechanisms that ultimately result in muscle relaxation. ATP acts as an inhibitory neurotransmitter together with NO, and the purinergic P2Y1 membrane receptor has been identified as a key item in order to understand how ATP may relax intestinal smooth muscle. Although, probably, no clinician doubts the significance of NO in the pathophysiology of digestive motility, the relevance of purinergic neurotransmission is apparently much lower, as ATP has not been associated with any specific motor dysfunction yet. The goal of this review is to discuss the function of both relaxation mechanisms in order to establish the physiological grounds of potential motor dysfunctions arising from impaired intestinal relaxation (AU)

Efectividad de la música, la técnica de respiración alternada y la palicación de manta de aire caliente durante la intervención de cadera sobre el dolor del paciente en el período perioperatorio / Music effectiveness, alternative breathign tecnique and hot air blanket application during hip intervention in patient´s pain while perioperative period

Introducción. Existen diversas intervenciones de enfermería para reducir el dolor y la ansiedad tras la cirugía, entre las que destacan: relajación sistemática, música, técnicas de distracción o aplicación de calor. Objetivos. Verificar si determinadas intervenciones enfermeras intraoperatorias disminuyen el dolor y la ansiedad posteriormente. Metodología. Estudio experimental de 129 pacientes sometidos a tres tipos de cirugía (prótesis total, parcial y osteosíntesis de cadera). La muestra se dividió en dos grupos: experimental (64 pacientes, a quienes se aplicó la intervención enfermera) y control (65 pacientes). La valoración de la ansiedad se llevó a cabo mediante el State- Trait Anxiety Inventory (STAI) y la del dolor con la Escala Numérica Verbal (ENV) y el consumo de analgésicos. Se realizó un análisis estadístico comparativo utilizando el programa SPSS. Resultados. Se encontraron diferencias estadísticamente significativas intergrupos en el nivel de ansiedad-estado tras la cirugía a favor del grupo experimental (p = 0.007). Respecto al dolor, se evidenció una tendencia decreciente en ambos grupos sin que las diferencias se revelaran significativas. Los menores de 70 años presentaban menor ansiedad-estado tras la operación. La prótesis total de cadera generaba menor ansiedad que las otras operaciones. Conclusiones. La intervención enfermera mostró su utilidad en la reducción de la ansiedad, pero no en la mejoría del dolor. Mientras que en el dolor crónico la ansiedad y la percepción dolorosa se reforzarían mutuamente, en el dolor quirúrgico agudo este vínculo sería más débil, lo cual explicaría los resultados obtenidos. No obstante, se precisan más estudios al respecto (AU)

Introduction. Diverse nursing interventions have been used to relief postoperative pain and anxiety, for instance: systematic relaxation, preoperative teaching visit, music, distraction techniques or warming methods. Aim. To verify if certain nursing interventions during surgery relief postoperative pain and anxiety. Methodology. Experimental study with 129 patients under three types of surgery (total and partial hip replacement and hip osteosynthesis). The sample was divided in two groups: experimental group (64 patients, who received the nursing interventions) and control group (65 patients). The State-Trait Anxiety Inventory (STAI) and the Numerical Verbal Scale (NVS) were used to measure postoperative anxiety and pain respectively. Analgesic drug administration was also registered. A comparative statistical analysis was carried out through SPSS computerized program. Results. Statistically significant differences between both groups ere found in state anxiety after surgery in favor of experimental group (P = 0,007). Postoperative pain reflected a decreasingly tendency in both groups but differences were not statistically significant. Patients younger than 70 years old suffered less state anxiety after surgery. Total hip replacement generated less anxiety than the other two operations. Conclusions. Nursing interventions showed effectiveness in postoperative anxiety amelioration but not in pain relief. While anxiety and chronic pain would mutually reinforce, in postoperative acute pain this link may be a weaker one; hypothesis that could explain the obtained results. However, new investigations re needed (AU)

Efectos de la musicoterapia durante el embarazo y el parto / Effectos of music therapy during pregnancy and labor

OBJETIVO: analizar y describir la mejor evidencia disponible sobre los efectos de la musicoterapia durante el embarazo y el parto. MÉTODO: revisión integrativa en la que se realiza una búsqueda bibliográfica en los principales buscadores y bases de datos biomédicas como son PubMed, Cuiden, Cinahl, Scielo, IME, Enfispo, Ebsco Host, Lilacs, Dialnet, Latindex, Cochrane Library y Portal Evidencia, desde enero de 2004 hasta julio de 2014. Los términos incluidos en la búsqueda fueron 'pregnancy', 'delivery', 'obstetric labor', 'childbirth', 'newborn' y 'music therapy'. Dichas palabras clave se combinaron con los operadores lógicos 'and' y 'or'. La elección de los artículos se realizó a través de la lectura del título y posterior lectura del resumen de los mismos que hacían referencia al objetivo de la revisión escritos en inglés. Los artículos seleccionados fueron revisados a texto completo y evaluados a través de los instrumentos de evaluación crítica Caspe. RESULTADOS: de todas las revisiones encontradas en las bases de datos, un total de 18 estudios fueron seleccionados a partir del título, de los cuales, que respondieran al objetivo, tan solo se encontraron a texto completo seis. Por último, los que cumplían con la mayoría de los criterios de evaluación y, por tanto, poseían una calidad entre media-alta o media-baja fueron seleccionados, realizándose finalmente la revisión de cuatro estudios. DISCUSIÓN Y CONCLUSIONES: se evidenciaron numerosos efectos al escuchar música, tales como el alivio del dolor durante las contracciones, la reducción de la tensión, la disminución de la ansiedad y del miedo. La musicoterapia provocó en las mujeres sensaciones de seguridad, tranquilidad, relajación y calma. Los recién nacidos que fueron expuestos a la música evidenciaron reacciones positivas cuando reconocieron las canciones escuchadas previamente

OBJECTIVE: to analyze and describe the best evidence available about the effects of music therapy during pregnancy and labor. METHOD: an integrative review where a bibliographic search was conducted in the main search engines and biomedical databases, such as PubMed, Cuiden, Cinhal, Scielo, Ime, Enfispo, Ebsco Host, Lilacs, Dialnet, Latindex, Cochrane Library and Portal Evidencia, from January, 2004 to July, 2014. The terms included in this search were: 'pregnancy', 'delivery', 'obstetric labor', 'childbirth', 'newborn' and 'music therapy'. Said key words were combined with the logical operators 'AND' and 'OR'. Article selection was conducted by reading the title and subsequently reading the abstract in English, which referred to the objective of the review. The complete text of the articles selected was reviewed, and they were assessed through the CASPE Critical Appraisal Tools. RESULTS: out of all reviews found in databases, 18 were selected by their title; and out of these, only six were found to refer to the objective in their complete text. Finally, there was a selection of those which met the majority of the assessment criteria, and therefore showed a medium-high to medium-low quality, and finally the review of four studies was conducted. DISCUSSION AND CONCLUSIONS: several effects were evident while listening to music, such as pain relief during contractions, a lower level of stress, as well as a reduction in anxiety and fear. Music therapy caused feelings of safety, tranquillity, relaxation and calm in women. Newborns who were exposed to music showed positive reactions when they recognized those songs they had listened to previously

El Hospital de Día-Centro Educativo Terapéutico Pradera de San Isidro. Un dispositivo para el tratamiento intensivo de trastornos mentales graves en niños y adolescentes / The Mental Health Day Care Hospital-Educational Therapeutic Centre Pradera de San Isidro. An institution for the acute treatment of severe mental disorders in children and adolescents

Los problemas de salud mental en niños y adolescentes son motivos de consulta frecuentes en Atención Primaria (AP). En la mayor parte de los casos, un tratamiento ambulatorio desde AP o desde su Centro de Salud Mental (CSM) es suficiente para una mejora significativa. Sin embargo, en ocasiones la sintomatología puede ser la manifestación de una estructuración psíquica seriamente dañada. En esos casos, donde existe un trastorno mental grave (TMG), es posible que dichos tratamientos ambulatorios no sean suficientes. En el presente artículo se presenta el Hospital de Día-Centro Educativo Terapéutico (HD-CET) Pradera de San Isidro. Un dispositivo de hospitalización parcial que forma parte de la red de Salud Mental de la Comunidad de Madrid, en el que se atiende a menores con TMG mediante un tratamiento ambulatorio intensivo. EL HD-CET consta de dos unidades: la de infantil (de 6 a 11 años) y la de adolescentes (de 12 a 17 años). Ambas cuentan con un equipo multidisciplinar de profesionales de Salud Mental, así como con un equipo docente encargado del aspecto académico de los pacientes. Se trabaja desde el modelo de comunidad terapéutica, procurando proporcionar al paciente experiencias emocionales correctoras que logren una mejora significativa y profunda del TMG (AU)

Child and adolescence mental health conditions are common in Primary Care (PC). In most cases, Mental Health Services (MHS) will achieve a good response in an outpatient basis. However, certain symptoms may indicate seriously damaged psychic structures, as found in Severe Mental Disorders (SMD), whose ambulatory care in PC and MHS may not be sufficient. Pradera de San Isidro Mental Health Day Care Hospital-Educational Therapeutic Centre (DCH-ETC) is part of Madrid Regional Mental Health Care Services, attending children and adolescents with SMD in a outpatient intensive program. DCH-ETC comprises a Children Unit attending patients of 6 to 11 years and an Adolescents Unit for patients from 12 to 17 years. A team of teachers is responsible for the continuing academic education of patients. With a Therapeutic Community model, the program aims to provide corrective emotional experiences leading to a deep and significant improvement in SMD (AU)

Headache in children: update on biobehavioral treatments.

Biobehavioral pain treatment consists of relaxation techniques, biofeedback treatment, operant pain treatment, pain coping, cognitive-behavioral treatment, and multimodal treatment. Especially in the treatment of pediatric headache, biobehavioral procedures have been found to be highly efficient and are widely accepted. They present similar effects as pharmaceutical treatments. In general, when standardized treatment programs are applied, the sessions are highly effective.

Estrés-recuperación en deportistas y su relación con los estados de ánimo y las estrategias de afrontamiento / Stress and recovery in athletes and their relationship to mood state disturbances and coping strategies

El objetivo del estudio es evaluar situaciones relacionadas con el sobreentrenamiento (RESTQ-Sport, Kellmann y Kallus, 2001; González- Boto et al., 2008c) en el contexto deportivo, e identificar su relación temporal con las modificaciones en los estados de ánimo (POMS, McNair y cols., 1971; Balaguer et al. 1993) y la posible influencia en la aparición de desequilibrios entre estrés y recuperación en función del tipo de estrategias de afrontamiento utilizadas (ISCCS, Gaudreau y Blondin, 2002; Molinero et al., 2006, 2008, 2009). Han participado 167 deportistas (62.5% hombres y 36.9% mujeres) entre 18 y 24 años pertenecientes a 11 modalidades deportivas. Los resultados muestran que se producen modificaciones a los largo de las tres tomas realizadas en los niveles de estrés general (p = .027*), conflictospresión (p = .000**), fatiga (p = .000**), bienestar general (p = .022*), burnout-fatiga emocional (p = .009**), forma física-lesiones (p = .000**), burnout- realización personal (p = .000**), autorregulación (p = .000**), Estrés no deportivo (p = .006**), Estrés y recuperación deportiva (p = .001**; p = .000**), Estrés Total (p = .001**) en relación a los índices medidos por el RESTQ Sport. A nivel emocional observamos cambios en los niveles de depresión (p = .040*), cólera, (p = .006**), confusión (p = 036*) y Alteración Emocional Total (p = .041*), y no se producen cambios en el uso de las distintas estrategias de afrontamiento. Es necesario prestar más atención a los cambios temporales durante la recuperación, que pueden inducir adaptaciones positivas tras periodos de sobreentrenamiento, y su relación con los estados de ánimo de los deportistas, que han sido utilizados habitualmente como indicadores de fatiga (González- Boto et al., 2009; Kellmann et al., 2001; Rietjens et al., 2005). Los deportistas utilizan una serie de estrategias de afrontamiento que podrían condicionar de forma diversa el balance entre estrés y recuperación y, por tanto, el posible desencadenamiento de situaciones de sobreentrenamiento (Márquez, 2006; González Boto et al., 2006, 2008a, 2009) (AU)

The aim of this study was to assess situations related to overtraining within the context of sport (RESTQ-Sport, Kellmann and Kallus, 2001; González-Boto et al., 2008c) and identify its temporal relationship with mood state disturbances (POMS, McNair et al., 1971; Balaguer et al., 1993) and its possible influence on the appearance of imbalances between stress and recovery according to the coping strategies used to deal with stress (ISCCS, Gaudreau and Blondin, 2002; Molinero et al., 2006, 2008, 2009). A total of 167 athletes (62.5% men, and 36.9% women) ranging in age from 18 to 28 years old in 11 sport modalities participated in the study. The results showed that modifications took place during the three measurements made of the levels of general stress (p = .027*), conflict/ pressure (p = .000**), fatigue (p = .000**), general wellbeing (p = .022*), burnout/ emotional fatigue (p = .009**), physical fitness/ injuries (p = .000**), burnout/ personal accomplishment (p = .000**), self-regulation (p = .000**), non-sport stress (p = .006**), sport stress (p = .001**), sport recovery (p = .000**), and total stress (p = .001**), which had changed compared with the main indices assessed by the RESTQ Sport. At the emotional level, we observed changes in the levels of depression (p = .040*), anger, (p = .006**), confusion (p = 036*) and total mood disturbance (p = .041*). We did not find any changes in the coping strategies used. According to these results, it is necessary to pay more attention to temporal changes during recovery, because they may lead to positive adaptations after overtraining periods and their relationship to athletes’ mood states, which have usually been used as fatigue indicators (González-Boto et al., 2009; Kellmann et al., 2001; Rietjens et al., 2005). Athletes use a number of coping strategies that may lead in different ways to the balance between stress and recovery and therefore, the possible triggering of overtraining (Márquez, 2006; González Boto et al., 2006, 2008a, 2009). This research project was supported by the Ministry of Science and Innovation (R+D Plan 008-2011) (Spain) (AU)

Behavioral treatment of headaches: extending the reach.

Behavioral treatments (predominantly biofeedback, relaxation, and cognitive-behavioral) have been utilized in headache management for many decades. Although effective, they have not been as widely implemented as desired, chiefly due to their time-intensive nature, special therapist qualifications, and patient costs. This paper focuses on ways to make these treatments more affordable and more readily accessible to patients. Various alternative delivery models have been explored. This paper reviews progress to date on three such approaches for treating recurrent headaches in adults--prudent limited office contact, Internet delivery, and mass media approaches. Clinical outcomes, advantages, and disadvantages of these approaches are reviewed in brief.

High and low trait anger, and the recognition of anger problems

This study compared three groups of people: (a) high trait anger individuals who recognized personal anger problems (HR); (b) high trait anger individuals who did not recognize personal anger problems (HNR); and (c) low trait anger individuals not reporting personal anger problems (LNR). Compared to LNR participants, HR and HNR groups reported more anger-out (i.e., outward negative expression of anger such as arguing with others), anger-in (i.e., anger suppression and harboring grudges), greater desire to use and actual use of physically aggressive anger expression (e.g., pushing or shoving someone), and less anger control-in (i.e., emotionally focused strategies to lower anger such as relaxation) and anger control-out (i.e., behaviorally focused strategies such as being patient with others). HR individuals reported more trait anger (i.e., higher propensity to experience anger) and less anger control-out than the HNR group. Gender did not relate to the recognition of anger problems. Findings were discussed with regard to theory and clinical implications (AU)

Esta investigación comparó tres grupos de personas: (a) individuos con alta ira rasgo que reconocieron tener problemas de ira (AR); (b) individuos con alta ira rasgo que no reconocieron tener problemas personales de ira (ANR); y (c) individuos con baja ira rasgo que informaron no tener problemas de ira (BNR). En comparación con los participantes BNR, los grupos AR y ANR tuvieron mayor ira-externa (i.e., manifestar negativamente la ira como discutir con otros), ira-interna (i.e., contener la ira y guardar rencores), mayor deseo de usar y emplear en los hechos expresiones físico agresivas de ira (e.g., empujar a alguien), menor control-interno (i.e., estrategias enfocadas en la emoción para disminuir la ira, tal como la relajación) y menor control-externo (i.e., estrategias enfocadas conductualmente como ser paciente con otros). Los individuos AR tuvieron más ira rasgo (i.e., mayor tendencia a sentir ira) y menor controlexterno que el grupo ANR. El género no se relacionó con el reconocimiento de problemas de ira. Los hallazgos se discuten con respecto a implicaciones clínicas y teóricas (AU)

El efecto de relajación en la percepción de la dinámica familiar de pacientes con trastornos de personalidad / The effect of relaxation on the perception of family dynamics of patients with personality disorders

Objetivo: Los objetivos de este estudio fueron conocer la percepción de la dinámica familiar de los pacientes en el primer y tercer mes de tratamiento y saber si existen diferencias entre los pacientes atendiendo a la presencia de trastornos de la personalidad. Material y métodos: La percepción de la dinámica familiar se evaluó a través del cuestionario FAP-FACES-IV, y un cuestionario de elaboración propia. El estudio se realizó en 76 pacientes. Resultados: Se han encontrado diferencias estadísticamente significativas entre las puntuaciones al inicio y a los tres meses de tratamiento. En todas las escalas del FAP han sido menores en la segunda evaluación. Estas diferencias y el nivel moderado de estrés percibido de los pacientes en la primera evaluación permiten confirmar la hipótesis de otros investigadores que atribuye a la percepción de la dinámica familiar un efecto de relajación que experimentan los pacientes al iniciar el tratamiento. Este efecto influye igualmente a los pacientes con trastornos de la personalidad. Conclusiones: El estudio muestra la importancia que tiene evaluar la dinámica familiar no solo al iniciar el tratamiento sino también en una etapa más avanzada del proceso terapéutico (AU)

Objectives: The aims of this study were to know the perception of the family dynamics of the patients in abstinence during the first and third month of treatment, and whether differences exist between patient responses to the presence of personality disorders. Material and methods: The perception of family dynamics were evaluated by questionnaire FAP-FACES-IV, and a questionnaire of own elaboration. The study was carried out 76 patients. Results: We have found statistically significant differences between the scores at the start and three months of treatment. At all FAP scales has been lower in the second evaluation. Along with these differences and the moderate level of stress perceived by patients in the first evaluation, to confirm the hypothesis of other researchers who attributed the perception of family dynamics of a relaxation effect experienced by patients when starting treatment. This effect also affects patients with personality disorders. Conclusions: The study shows the importance of assessing family dynamics not only in the initiation of treatment but also in a more advanced stage of the therapeutic process (AU)

Behavioral medicine for migraine and medication overuse headache.

Primary headaches, including migraine and medication overuse headache (MOH), can be conceptualized as biobehavioral disorders based on the interaction of biological, psychological, and environmental factors. This article reviews empirically supported and efficacious behavioral approaches to the treatment and management of headaches in general, with an emphasis on migraine and MOH from a biopsychosocial perspective. Evidence-based behavioral medicine treatments for migraine and MOH are reviewed, including patient education, cognitive behavioral therapy, and biobehavioral training (biofeedback, relaxation training, and stress management). Information regarding psychological comorbidities and risk factors for progression of migraine and the development of MOH is also reviewed. Strategies are provided for enhancing adherence and motivation, as well as facilitating medical communication.

O relaxamento respiratório no manejo do craving e dos sintomas de ansiedade em dependentes de crack / Deep breathing in the management of craving and anxiety symptoms of crack-cocaine-dependent patients

Introdução: O objetivo deste estudo foi verificar a efetividade do relaxamento respiratório no manejo do craving e dos sintomas de ansiedade em dependentes de crack internados para tratamento em uma unidade de desintoxicação. Método: Ensaio clínico do tipo quase-experimental de análise quantitativa. A amostra foi por conveniência, sendo composta por 32 homens dependentes de cocaína (crack). Eles tinham a cocaína como a droga de escolha e haviam utilizado esta substância por última vez entre 2 e 3 semanas antes do início do tratamento, conseguindo realizar a técnica do relaxamento respiratório adequadamente do ponto de vista biomecânico. Os instrumentos aplicados foram: Cocaine Craving Questionnaire-Brief (CCQB), escala analógica visual (EAV), Inventário Beck de ansiedade (BAI) e ficha com dados sociodemográficos e referentes ao padrão de consumo de substâncias psicoativas (FSD). Foi realizada uma intervenção em grupo na qual, inicialmente, foram aplicados o CCQB, a EAV e o BAI. Depois, foram apresentadas imagens relacionadas ao uso do crack e foram reaplicados os mesmos instrumentos. A seguir, foi realizado o relaxamento respiratório durante 10 minutos e foram aplicados, pela terceira vez, os instrumentos. Após esta intervenção, foi realizada uma entrevista individual com aplicação da FSD. Resultados: Os resultados desta pesquisa demonstraram uma redução dos escores do CCQB, da EAV e do BAI pelo relaxamento respiratório em uma amostra cujo perfi l corresponde ao padrão geral dos usuários de crack. Conclusão: Este estudo, apesar de ter algumas limitações metodológicas, sugere que o relaxamento respiratório pode ser uma estratégia efetiva no manejo do craving e dos sintomas de ansiedade em dependentes de crack.

Introduction: The objective of this study was to verify the effectiveness of deep breathing in the management of craving and anxiety symptoms in crack-cocaine-dependent patients hospitalized for treatment in a detoxification unit. Method: This is a quasi-experimental clinical trial using a quantitative analysis. The convenience sample comprised 32 crack-cocaine-dependent males. These subjects had cocaine as their drug of choice, having used this substance between 2 and 3 weeks prior to the beginning of the treatment, and were able to adequately perform the deep breathing technique. The instruments used were: the Cocaine Craving Questionnaire-Brief (CCQB), the visual analogue scale (VAS), the Beck Anxiety Inventory (BAI), and a form containing sociodemographic information and data related to the pattern of consumption of psychoactive substances (SDF). A group intervention was conducted with the administration of the CCQB, the VAS, and the BAI. After that, images related to the use of crack-cocaine were shown to the subjects and the same instruments were administered again. Next, the participants performed the deep breathing technique for 10 minutes, and the instruments were administered one more time. Finally, an individual interview was done and the SDF was completed. Results: Our findings demonstrated a decrease in the scores on the CCQB, the VAS and the BAI after the deep breathing technique was performed in a sample whose profile represents the general pattern of crack-cocaine users. Conclusion: In spite of some methodological limitations, the present study suggests that the deep breathing technique is effective in the management of craving and anxiety symptoms in crack-cocaine-dependent patients.

Entrenamiento en relajación como terapia complementaria en pacientes con gastroenterología / No disponible

Aunque la etiología de la enfermedad de Crohn es desconocida, se han descrito factos de carácter genético, infecciosos, inmunológico, y ambiental que aumentan el riesgo de padecerla, entre otros, eventos estresantes que exacerban o agravan la enfermedad. Desde el año 200 6, este mal, englobado dentro del grupo de las enfermedades inflamatorias intestinales (E.II, I.B.D.) clasifica a los pacientes en función de la edad de comienzo, localización de la enfermedad y comportamiento de ésta. Como es bien conocido, actualmente no es curable, pero sí controlarle, y la mayoría de las personas pueden hacer una vida normal, bajo tratamiento y vigilancia. Paralelamente a los tratamientos de tipo farmacológico, dietético, sintomático o quirúrgico, el poder proporcionar técnicas de relajación a los pacientes con trastornos gastrointestinales, que puedan aplicar fácilmente en cualquier momento puede convertirse en una inestimable herramienta que les ayude al control de su propia salud. El estudio muestra los beneficios obtenidos al comparar una muestra de pacientes de Crohn que siguieron un entrenamiento en relajación y lo incorporaron a su vida cotidiana, comparado con otro grupo de pacientes de la misma enfermedad, sin tratamiento(AU)

Massage or music for pain relief in labour: a pilot randomised placebo controlled trial.

Research on massage therapy for maternal pain and anxiety in labour is currently limited to four small trials. Each used different massage techniques, at different frequencies and durations, and relaxation techniques were included in three trials. Given the need to investigate massage interventions that complement maternal neurophysiological adaptations to labour and birth pain(s), we designed a pilot randomised controlled trial (RCT) to test the effects of a massage programme practised during physiological changes in pain threshold, from late pregnancy to birth, on women's reported pain, measured by a visual analogue scale (VAS) at 90 min following birth. To control for the potential bias of the possible effects of support offered within preparation for the intervention group, the study included 3 arms--intervention (massage programme with relaxation techniques), placebo (music with relaxation techniques) and control (usual care). The placebo offered a non-pharmacological coping strategy, to ensure that use of massage was the only difference between intervention and placebo groups. There was a trend towards slightly lower mean pain scores in the intervention group but these differences were not statistically significant. No differences were found in use of pharmacological analgesia, need for augmentation or mode of delivery. There was a trend towards more positive views of labour preparedness and sense of control in the intervention and placebo groups, compared with the control group. These findings suggest that regular massage with relaxation techniques from late pregnancy to birth is an acceptable coping strategy that merits a large trial with sufficient power to detect differences in reported pain as a primary outcome measure.

Pediatric headache: an examination of process variables in treatment.

The goal of this article is to provide a rational methodological review of studies addressing the treatment of childhood headache. In particular, the goal is to provide a review of process variables that may be associated with the efficacy of behavioral and psychological treatments for childhood headache. A search for studies that examined the efficacy of treatment for headache among children younger than 12 years of age was conducted using Medline from 1966 to 2005. A total of 9 studies were selected for the present systematic review. The findings from this study suggest that although research supports the use of behavioral treatments for headache among this patient population, process variables such as child demographics, as well as treatment characteristics such as time in treatment, may moderate treatment efficacy.

Behavioural treatments: rationale and overview of the most common therapeutic protocols.

The view of headache as a psychophysiological disorder predates contemporary behavioural research and also the concept that psychosomatic illnesses are the result of specific emotional conflicts that eventually produce physical symptoms. Behavioural interventions include strategies for the identification and modification of behavioural headache triggers and the acquisition and use of self-regulation skills aimed at prevention of headache episodes. Consequently, research in behavioural medicine has matured scientifically, although methodological imperfections have had an impact on contemporary headache management. The evidence suggests that the level of headache improvement with behavioural interventions may rival those obtained by using medications. As side effects and complications are minimal, these approaches are optimal options for young patients or for patients where the medications remain contraindicated.