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Pain

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Unpleasant sensory experience due to stimulation of nerve endings Symptom May warn us of injury or disease Emotional or psychological distress Overwhelming and intolerable Socially disruptive

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Types of Pain

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Headaches and Backaches

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Pain Treatments

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OTC NSAIDs Hypnosis Acupuncture Massage therapy TENS (electrodes) Chiropractor adjustment Biofeedback Relaxation therapy Distraction Redefinition of the situation

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Factors of pain

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Biological Psychological Sociocultural

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Biological factors of pain

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Transmission of pain to a conscious level in the brain and in the medical management of pain

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Psychological factors of pain

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Reactions, meanings, interpretations, and expressions of pain Including emotional or affective responses to pain such as fear and depression Pain threshold

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Psychosocial factors of pain

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Include improvement in self-efficacy along with changes in attitudes, emotions, and pain related behaviors

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Social and cultural factors of pain

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National origin, ethnicity, educational level, and socioeconomic statues, affect treatment and recovery from painful conditions Some praise those who tolerate pain as being brave Stoic

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Social Support of pain

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Includes friends and family members who are willing to assist patients in reducing stress, fear, pain, and discomfort Pain support groups

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Biological definition of pain

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An unpleasant sensation resulting from situations of nerve ending injury, disease, or other harmful factors

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Reaction to pain

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Medications Seeking medical care

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Anguish

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Severe pain that continues for long periods of time

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Pain and Stress

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Pain is an important cause of stress, an stress can also cause pain Ex. Migraines and headache

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Chronic pain Examples

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Back Pain Joint pain Arthritis Rheumatism

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Nociception

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Perception of pain produced when body tissue is damaged

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Pain results when? Where does it move?

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Sensory nerve fibers are irritated by injury or disease Moves from the site of injury or disease through the spinal core to the brain and consciousness

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Endorphins

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Block the sensation of pain

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Visceral pain

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Results from injury or disease to an organ in the thoracic or abdominal cavities

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Somatic pain

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Originates in the skin, ligaments, muscles, bones, and joints

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Sensations of pain

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Numbness Tingling Burning

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Tenderness

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Refers to a slight but unusual pain when affected area is touched or pressed

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Biological usefulness of pain

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Warns us of damage to our bodies

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Pain behaviors

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Hear a groan Grasp to some part of they body Cry Moaning

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Distorted ambulation

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An abnormal walking behavior indicating pain in some area of the body Difficultly walking

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Guarding

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Protective behavior that may indicate a painful injury

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Pain Threshold

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The point at which an individual describes a sensation as being painful

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Tolerance

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To the point at which people want the sensation to stop The older a person is, the great the tolerance for pain

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Psychogenic pain

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A chronic pain with no currently identifiable physical basis

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Stoic

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A person who is a patient and who endures adversity including pain

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Socialization

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Process of teaching or learning what behavior is acceptable Attitudes about pain are learned in the family Distraction helpful for children

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Secondary gain of pain

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Any benefit of pain used by persons to avoid some task to to draw attention to themselves

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Malingering

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Medical term for patient exaggeration about symptoms of a disease or injury to gain some end

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Biological causes of Headaches

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Sinus infections, flu, dehydration, tumors, allergies, changes in air pressure

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Psychological causes of headaches

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Difficult to separate from social because most stressors include both components Stress related headaches caused by anxiety or worry

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Specificity theory of pain

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Suggested that sensory receptors in the skin were specific to pain sensations

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Pattern theory of pain

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Proposed that the pattern and quantity of nerve fiber discharged produced differences in pain sensations

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Gate control theory of pain

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Most widely accepted pain theory (biopsychosical) Explains pain as a sensation that can be blacked by a neutral gate in the spinal cord that modifies pain signals Information can also move int he apposite direction

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Neuromatrix model of pain

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Merges the gate control theory with the concept of stress Pain is a unique experience for each individual

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Actue pain

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Comes on suddenly and is severe Indicates tissue damage Prevents further damage

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Chronic pain

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Persists for a very long period of time, usually more than 6 months Even after body tissue appears to have healed Rarely cured but can be managed Accompanied by depression and frustration

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Recurrent pain and chronic intermittent pain

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Brief but acute pain episodes repeated over and over and distressing to patients

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Three Stage Diathesis-Stress Model

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Patents become increasingly demoralized due to the stress of coping with pain

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Three Stage Diathesis-Stress Model : Stage 1

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Fear, anxiety, and worry about the pain and its cause

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Three Stage Diathesis-Stress Model: Stage 2

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Characterized by the negative affect or emotions such as helplessness, depression, anxiety, and anger

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Three Stage Diathesis-Stress Model: Stage 3

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Patients accept that a pain is chronic and adopt a maladaptive sick role to behavior

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Chronic intermitten pain

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Arthritis: Weather Migraines: Social situations Sinus headache Comes and goes and is often unpredictable

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Chronic intractable pain

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Severe and constant, often triggered by sociopsychological events Lower back pain or headaches

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Progressive pain

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Gets worse over time

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Referred pain

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Pain due to confusion of sensations within the nervous system Felts in one part of the body, but the injury or disease is actually in another part

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Phantom limb pain

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Persistent pain perceived to be located in a part of the body that was removed or amputated

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Pain syndrome

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A combination of sings an symptoms More than 14 pain syndromes

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Pain syndrome include

answer

Whiplash Back pain Headaches Cancer pain Pain from Muscular dystrophy MS Herpes Zoster Rheumatic disease Sickle-cell disease

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Signs of Pain

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Objective indicators of an injury or illness that can be obsessed by medical personal Ex. vomiting, bleeding

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Symptoms of Pain

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Subjective indicators of pain that must be reported by patients PAIN IS A SYMPTOM

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JCAHO

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Requires the use of scales to document pain severity

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Measurement of Pain

answer

Visual Analogue Scales The McGill-Melzack Pain Questionnaire Physiological Measures

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Visual Analogue Scales

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Usually ask about the amount of pain from a range of 1 to 10 Posters with a sequence of faces

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The McGill-Melzack Pain Questionnaire

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Allows patients to select words that fit their pain Amount of pain and qualities of pain 3 classes of pain descriptions, 20 subclasses, and over 100 adjectives Score pain from 1-7

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Physiological Measures

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Assessment of movement

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Pain management is based on 3 separate stages

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Primary Management Secondary Management Tertiary Management

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Primary pain management

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Appropriate for short-lived and less severe acute pain Information and encouragement so patients can return to the sam activity level that existed before the injury or disease Analgesics

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Analgesics

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Relieve pain and allow healing

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Secondary pain management

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More intensive psychosocial interventions promote a return to pre-pain productivity levels to prevent further deterioration in the patient's biological and psychological well-being

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Tertiary pain management

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Intense interdisciplinary treatments to offset physical deterioration and prevent permeant disability

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Biological Approaches to Pain Management

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Pharmacological treatments Prescriptions Anesthesia

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General Anesthesia

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Results in unconsciousness for surgery

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Local anesthesia

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Numbness is limited to specific nerves

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Epidural anesthesia

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Prevents pain below a certain point on the body

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Two solutions to tolerance

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Patient-controlled analgesia Continuous Infusion

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Patient-controlled analgesia

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Allows patients to activate doses of medicine for their pain Doses are controlled Ex. Opiate Analgesics

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CARF

answer

The Commission on Accreditation of Rehabilitation Facilities Requires that a pain management team include a physician who acts as director of the treatment plan Meet once a week Functional restoration is the goal

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Psychosocial Approaches to Pain Management

answer

Biofeedback Relaxation Training Hypnosis PT, TENS, and Massage Chiropractic Acupuncture Herbal Therapy

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Complementary health care or alternative medicine

answer

Refers to therapeutic interventions developed outside of traditional Western medical practice that may be used in combination within traditional medical treatments

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Examples of Complementary health care or alternative medicine

answer

Acupuncture Massage Relaxation therapy Self-help groups Herbal medicine Megavitamins Chiropractics Self-hypnosis

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Bio-feedback

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Requires special training, equipment, and time on the part of both the therapist and patient Used in behavioral medicine and clinical psychology to treat pain and stress in muscle tension

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Muscle relaxation

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Coping with stress and is also appropriate for pain management to relax without the electrodes of biofeedback

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Hypnosis

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Similar to relaxation trying and biofeedback Puts individuals in a highly focused state/altered state of consciousness

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PT, TENS, Massage

answer

PT: Used in addition to traditional medical approaches for injury and pain TENS: Transcutaneous electrical nerve stimulation Massage: Manipulation of soft tissue to reduce pain and stress

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3 types of massages

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Swedish Shiatsu Rolfing

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Swedish

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Tissue is kneaded

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Shiatsu

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Manipulated the pressure points

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Rolfing

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Deep muscle massage

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Chiropractic

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Ease pain and suffering though manipulations of joints and other parts of the body 3rd largest group of health care providers

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Acupuncture

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Ancient traditional healing and pain-control technique practiced by over 2,500 years in China Health problems arise from an imbalance of energy in the body Needles

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Herbal Therapy

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Plant-based or botanical medicines are used to relieve pain

question

Cognitive techniques

answer

The least invasive of pain control methods, they involve changing thinking about pain and pain perspectives Meditation Deep Breathing Progressive muscle relaxation Distraction Redefinition

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Distraction

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Used for pain control and stress management Works best with mild to moderate pain useful for short-term pain relief of about 3 days

question

Norman Cousins

answer

Credited with "laugh therapy"

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"laugh therapy"

answer

Related to distraction, relaxation, and pain control

question

Redefinition

answer

Related to distraction and is used by therapists to change the ways we think about chronic stressors like pain Substitutive constructive thoughts to replace their fears Coping statements

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Stress has:

answer

Biological Psychological Sociocultural CAUSES

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Biological

answer

Physiological responses in the nerves and endocrine systems that may cause both immediate and long term threats to health

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Psychological

answer

Based in each individual's perception of a problem or trouble

question

Sociocultural

answer

Individual's reactions to stressful situations and influenced by social and cultural experiences in their past, present, and future

question

Stress

answer

A physical and psychological reaction to a threat to physical, psychological, or social health

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Stressor

answer

An event or situation perceived by persons to be a danger to their physical, psychological, and social health

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Mind-body connection

answer

Idea that emotions, personality, and culture affect physical health and that the revers his also true

question

Panic Disorder (PD)

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A tendency of humans to experience fear and anxiety in many situations where dangers are either imagined or real

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Post-Tramatic stress disorder (PTSD)

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Anxiety disorder that occurs after having experienced a serious threat of death or injury to oneself or others

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3 different ideas of stress:

answer

Stimulus Response to the stimulus Interaction between the two

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Coping

answer

Strategies or processes used by individuals to deal with stressors or demands Respond

question

Distress

answer

Indicated an unpleasant state of suffering

question

The Flight or Flight Syndrome by?

answer

Walter Cannon Biological

question

The Flight or Flight Syndrome

answer

The response of animals when threatened with harm Arousal by the sympathetic nervous and endocrine system to attack of flee After danger over bodies return to homeostasis

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Homeostasis

answer

Bodies normal state In balance Back to the warm/happy place

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General Adaptation Syndrome (GAS) by?

answer

Hans Selye Biological

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Steps of GAS?

answer

Alarm Resistance Exhaustion

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Alarm

answer

The body is mobilized through the nervous and endocrine systems to fight or flee

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Resistance

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The body's immune system is in jeopardy and people may become ill

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Exhaustion

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The body is in a low level of functioning until either recovery or death occurs

question

Physiological Reactions to Threats

answer

Neuroendocrine Responses

question

Neuroendocrine Responses

answer

Cells in the central nervous system control and coordinate all body functions in response to stress SAM and HPA system involved

question

Symatho-adrenomedullary (SAM) and Hypothalamus-pituitary-adrenocortical (HPA)

answer

Release catecholamines such as epinephrine and norepinephrine into the body

question

Autonomic nervous system

answer

Affects involuntary action so conscious control is not required

question

Sympathetic nervous system

answer

Mobilized the body to meet threats

question

Parasympathetic nervous system

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Part of the nervous system that shows the heart rate, dilated blood vessels, and relaxed muscles stimulating digestion

question

Endocrine system

answer

Network of glands that secrete hormones into the bloodstream

question

Richard Lazarus

answer

Theory of Stress Psychosocial

question

Theory of Stress

answer

A person's perception and interpretation of a stressful situation are more important than the reality of the event People can learn to cope or respond to stress in healthful way

question

Transactional Analysis by?

answer

Richard Lazarus and Susan Folkman

question

Transactional Analysis

answer

Continuing exchange between people and their social and physical environments

question

3 stages of Transactional Analysis

answer

Primary Appraisal Secondary Appraisal Reappraisal

question

Primary Appraisal

answer

Different people will view identical situations as threatening, as harmless, or as a helpful opportunity One you can learn or run from

question

Secondary Appraisal

answer

If a situation is judge to be a threat than people consider their options and devise strategies High levels of self-efficacy for the situation, they will not feel threatened

question

Self-efficacy

answer

Confidence to be successful

question

Reappraisal

answer

People often reevaluate situations due to new information and judge situation to less of a threat

question

U-stress

answer

Stress you can use Good stress

question

Example of measurement of stress

answer

Polygraph tests Heart rate Blood pressure

question

Polygraph tests

answer

Results are objective and quantifiable but are unreliable, expensive, and invasive

question

Social Readjustment Rating Scale

answer

An effort to assess the effect of stressors on health Created by Holmes and Rahe 43 life events ranging from death of a spouse (100 points) to minor violation of the law (11 points)

question

Perceived Stress Scale (PSS)

answer

Cohen, Kamarck, and Mermelstein 117 item questionnaire measuring the severity and frequency of minor stressors and an uplifts scale to measure positive life events

question

Psychoneuroimmunology (PNI)

answer

A science studying the bidirectional connections between behavior and the nervous, endocrine, and immune system

question

Causes of Stress:

answer

Mind-body damage Changes in Immune system Unhealthy behavior

question

Mind-body damage

answer

Respiratory disorder Skin disorder Cancer

question

Changes in Immune System

answer

Suppression of T- and B-cell functions Decreased interferon synthesis

question

Unhealthy behavior

answer

Smoking Alcohol abuse Drug abuse Poor diet

question

Biological stressors

answer

Pathogens Physical injuries

question

Psychological stressor

answer

Humiliation

question

Psychosocial stressor

answer

Being chased across campus by an angry mob

question

Type A personality

answer

A person who tried to do more and more in limited periods of time and often ignores symptoms of physical illness

question

Acute Stressors

answer

Catastrophic events or sudden aggravations in the environment involving coping effort

question

Chronic Stressors

answer

Aggravations that last months to years

question

Immunology

answer

Study of the body's response to foreign invasion

question

Human Immunodeficiency Virus (HIV)

answer

Is a contagious, life-threatening deficient of the immune system

question

Acquired immune deficiency syndrome (AIDS)

answer

HIV many progress to this

question

Anaphylactic shock

answer

Serious allergic response to insect stings, foods or to medicines

question

Psychoneuroimmunology (PNI) three areas of study:

answer

Negative Emotions Contribute to Illness/Death Stress and Chronic Health Problems Stress Influences Health Habits

question

Negative Emotions Contribute to Illness/Death

answer

Negative emotions intensify the threats to health Depression, anxiety, anger, and hostility

question

Depression

answer

The most common psychiatric illness

question

Stress and Chronic Health Problems

answer

Stress contributes to poor health habits

question

Stress Influences Health Habits

answer

Stress interferes with important social relationships

question

Atopic Dermatitis (AD)

answer

Or eczema, is a neurodermatitis characterized by itching, redness, oozing, crusting, scratching, and thinking of the skin

question

Naturalistic Stress

answer

A stressor faced outside of laboratory testing situations ex. taking exams

question

Norepinephrine

answer

A hormone recreated by the adrenal medulla Involved in memory

question

Combat Stress Reaction (CSR)

answer

Name given to the reaction of some American soldiers to the stress of combat in WW II

question

Resilience

answer

Refers to an ability to maintain balance in the face of trauma and loss

question

Rehabilitation psychology

answer

Focuses on the post-injury phase and center on helping people with disabilities to recover from injuries and disease

question

Stress fractures

answer

Physical injuries usually resulting from reptile impacts on limbs

question

2 theories to explain the relationship between stress and sports injuries:

answer

Stress interferes with concentrations Physical arousal of stress combined with competitive spirit increases muscle tension and reached muscle coordination

question

Biological Approaches to Sport Injury Prevention

answer

Maintaining a regular training program

question

Psychological Anpporaches to Sports Injury Prevention

answer

Clear they minds of negative emotions Visualize successful performances

question

Stress management

answer

Interventions or programs designed to improve people's ability to cope by increasing they knowledge and skills

question

Competent coping

answer

Contributes to biological, psychological, and socicultrual health

question

Proactive coping

answer

Actions to prevent exposure to known stressors

question

Biofeedback

answer

A cognitive-behavioral instructional process combining talk therapy with technology to teach individuals to gain control over anxiety, tension, or pain

question

Stress inoculation training (SIT)

answer

Cognitive-behavior therapy designed to immunize people against stress

question

3 Stages of SIT

answer

Conceptualization Skills development and application Coping skills

question

3 heavily researched moderators of stress

answer

Coping Social Support Stress management interventions

question

Guided Imagery

answer

Imageine a pleasant relaxing situation

question

Deep breathing

answer

Give attention only to one's breathing rather than thinking about anything else

question

Progressive muscle relaxation (PMR)

answer

First tensing and than relaxing muscle groups

question

Appraisal

answer

1st stage coping process in which persons think about a stressor or demand upon them

question

2 General Types of Coping

answer

Problem-focused coping Emotional focused coping

question

Problem-focused coping

answer

Aims at managing a stressor

question

Emotional focused coping

answer

Managing feelings aroused by stressor

question

Emotional disclosure

answer

Relieving stress from a traumatic event by talking with someone or writing it

question

Avoidant coping

answer

Reacting to a stressor by denial or minimizing a threat

question

Cognitive Coping

answer

Thinking, learning or the process of knowing or interpreting

question

Social Support

answer

Efforts by others to make us feel loved and valuable

question

Structural support

answer

Includes networks of close social ties

question

Functional support

answer

Provides resources

question

Personality

answer

Aspects of an individual that may be reveled through conversation and other activities

question

Resilience

answer

The capacity to recover quickly

question

Hardiness

answer

Ability to withstand stressful events and take approbate and decisive action

question

Learned resourcefulness

answer

Skills of a persons who learn to anticipate, plan, self-regulate, cope with failure, and change coping strategies

question

Biological Approaches to Stress Management

answer

Stay physically fit Regular aerobic exercise Being well rested Good decisions Medications Counseling Control body tension Muscle Relaxation

question

Psychosocial Approaches to Stress Management

answer

being mentally fit Meditation Reading therapy relaxation TM

question

Transcendental Meditation (TM)

answer

A form of reflection that instructs people to choose a mantra or secret word to be repeated over and over in order to focus thoughts away from stressful ideas

question

Meditation

answer

Using the mind-body connections to improve health

question

Mindfulness meditation

answer

Focus on the present moment and on noting else

question

Stress Inoculating Training (SIT)

answer

Form of cognitive therapy designed to immunize people against stress

question

SIT 3 stages

answer

Conceptualization Skills development Application

question

Redefinition

answer

Stress management technique Substitutes positive constructive thoughts for frightening ones

question

Affirmations

answer

Statements about one's ability to overcome adversity

question

3 characteristics of being hardy

answer

Commitment Control Challenge

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