abatson

Forum Replies Created

Viewing 15 posts - 1 through 15 (of 33 total)
  • Author
    Posts
  • in reply to: Phantom Limb Pain #2575
    abatsonabatson
    Moderator

    Yes, all of these techniques apply to phantom limb pain. The mirrors are just another way of tricking the brain into believing things are ok. It can work, but so can these talk methods. Remember that pain is just the brain’s opinion of the state of things. If we can change the brain’s opinion then we can turn off the threat signaling which will stop the pain. The mirrors can teach the brain that it is safe too (through visual trickery/illusion).

    in reply to: mixed pain syndromes #2574
    abatsonabatson
    Moderator

    I think it is important to first consider if this assumption of a “mixed picture” is accurate. We know the body heals – muscles, tendons, ligaments, bones, etc. heal in a finite period of time – short of some sort of environment where it is not allowed to heal, like a broken bone that is not aligned and keeps moving around or a tissue wound in someone with diabetes. If the pain has been present for >3-4 months, why has it not healed? or is it mind-body? Secondly, it is important to pull back and see the big picture – is the particular symptom occurring in someone with multiple other pains at the same time, or a history of mind-body conditions over time, with risk factors, etc.? If it is, then maybe colluding in this assumption of a mixed picture is not what your role should be in the patient’s care – maybe you should be questioning the validity of the diagnosis or at least, really focusing on the component that is mind-body. Third, have you looked at the xrays (I’m sorry – I don’t know your profession, so this may not apply). Do you know they have a tendinopathy or was this just what someone told the patient who told you. What is the evidence for the structural diagnosis? Also, if they truly have a tendinopathy which can be painful (I think), is it really catastrophizing? or is it just painful? Lastly, anyone who has a structural painful condition for more than 3 months, will likely have a mind-body condition on top of it all – this is just how the human brain works – few people can not be afraid or avoidant of pain for that long without activating fear circuits in the brain. To the degree that their symptoms are driven by conscious or subconscicous fear circuits, the neuroscience education and specific techniques can be helpful.

    in reply to: Workshop Videos #2573
    abatsonabatson
    Moderator

    Hi Dawn,
    Workshop 6 has been posted in the workshop videos forum – this one. Sorry for the delay. Regarding the “presentations” for workshops 1 and 2, what specifically are you asking for? My treatment checklist will be emailed to everyone soon.
    Alicia

    in reply to: Mind-body connection with Cortisol, inflammation #2445
    abatsonabatson
    Moderator

    Hi Rachel,
    I am definitely no expert in this area, so I will just share with you my understanding. First, I’m not familiar with using prednisone for the treatment of some of the conditions you mentioned as a standard of care, so I can’t speak to that. However, when prednisone is used for conditions such as asthma or auto-immune conditions, there is good bench research showing its affects on the immune system. I would think of endogenous prednisone as more of an immune system “regulator” than a “suppressant”. When the body gets injured, prednisone is released to regulate the immune response and healing mechanisms. You would not want the body to overactive the immune system because you would end up dieting of the strong immune response. This situation can happen in asthma attacks, sepsis and even those who died of acute Covid infection. It was the immune system which created the physiologic environment that lead to the person’s death. So, cortisol is there to tamp it down so it doesn’t over-react. In auto-immune conditions, the body is now attacking its own tissue, so suppressing the response with cortisol is helpful so the tissues have a chance to heal. Here is a paper explaining in detail what research shows about how cortisol regulates the immune response, but even this article is a little outdated.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751559/
    Hope something here addressed your thoughts.
    Alicia

    in reply to: patient population considerations #2421
    abatsonabatson
    Moderator

    I agree that different people may need different approaches. This work is definitely not cookie cutter and we have to meet the patient where they are. I have worked in community mental health care settings located in underserved areas with underserved populations. Needs of safety come first, so helping a patient obtain needed resources for food, housing, transportation and personal safety usually take priority. After that, if a patient has high levels of anxiety, which often correlates with high levels of trauma (though not always), working on the skill of self-soothing and self-compassion skills comes next. Once they can bring down their anxiety levels so that they are not always in full panic, then they can better focus on how periodic shifts in anxiety and pain correlate with mental/emotional/present stressors. Then, they can begin to do the pain reprocessing therapy work and if that is not resolving everything, I will turn towards the emotional processing work. However, this is just a very general guide. I have also been known to do emotional processing work on the first visit and it has been very affective. Over time, you get a sense of where the patient is and what is driving their danger signal – in the moment. Sometimes, they just need to tell their story – it might be the very first time they have told anyone who took the time to listen. I have worked with homeless who have done well, but they had lower levels of anxiety. I don’t find lower socio-economic status to be a barrier – I really think it depends on the individual and what whether they are open to it or not. Some people associate more biomedical care with being acknowledged and affirmed and are reluctant to consider a non-biomedical approach, feeling like their needs are being ignored or diminished. This is unfortunate, because with more biomedical care and attention, in these cases, the negative outcomes are greater.

    in reply to: Seventy year old woman with Neurologic symptoms #2390
    abatsonabatson
    Moderator

    I like that you encouraged her to think about it. Sometimes, a patient will come back 1-2 visits later with an “ah-ha!” moment of realization. Also, so many times, they aren’t really sure if the stressor “counts” as a stressor. They will minimize, laugh about it, make a sarcastic statement or put themselves down – all clues that there is something deeper or something they feel uncomfortable with. Today, a patient told me his childhood was great, not stressors however, by the end it came to light that his parents NEVER hugged him or his sister or said I love you until 3 months ago (he is 44 years old!). He laughed about it. He has an adult pattern of having relationships with women with whom he “can’t see the red flags”. He doesn’t understand what normal affection looks like, sounds like or feels like. That is a very different example compared to what you were talking about, but I just bring it up to show how complex these memory associations can be.

    in reply to: Dementia #2389
    abatsonabatson
    Moderator

    I have had MBS patients complain of “brain fog” and memory disturbances which do get better and resolve over time with treatment. I, myself, recall realizing that I could no longer do math in my head when I was sick. I got back this skill after a few years of recovery/post-recovery and feel like my brain is working just fine now, but I do feel like it took a few years to feel that way and I found the more I challenged it (by returning to work and taking on more multi-tasking, the better it has gotten. I have also had patients who were clearly getting dementia, beginning to have memory disturbances, and I was not able to help them because they had high degrees of anxiety and also, could not remember what we talked about in each session, so couldn’t implement the tools and techniques to recovery. It might be helpful to know what testing, if any, the neurologist did. Was neuro-psych testing done? Was a brain MRI done? If those are normal and basic labs are normal, it would seem more like MBS. I have also seen situations where someone goes from totally normal in their early 80’s, undergoes a severe stressor which leads to chronic anxiety, chronic somatic symptoms and ultimately deteriorates into severe dementia and death. I don’t know if that would have happened anyway without the stressor and anxiety. I think lack of self-confidence and fear can really impair our abilities to focus and thus, to remember. Our brain can’t generally do math while we are busy fighting tigers all day! There was a study about 8 years ago that showed an ASSOCIATION between benzodiazepine use and risk of dementia, then a later study that clarified that the real risk was chronic anxiety, not the benzodiazepine use. Any treatment that decreases the amount of fear we live in on a daily basis is going to improve our body’s physiology and function, so I would encourage your patient to try and not focus on the memory problems – this will just cause more angst and fear as he is trapped in the “fear -memory loss- fear cycle”- and instead focus on “turning off the danger signal”. Having said that, if he is not getting enough oxygen via CPAP, that will also cause his brain to work suboptimally and lead to cognitive problems ….It is very impressive to see someone go from suffering from severe untreated OSA to suddenly being treated with effective CPAP – really night and day difference on their overall health and well-being. We need oxygen 🙂 If he is truly having oxygen deprived periods due to not using CPAP, it might be good to work on his CPAP phobia first.

    in reply to: Question about emotions #2384
    abatsonabatson
    Moderator

    This is a great conversation – and a complex one. My understanding from taking a couple of Allan Abbas’ courses is that it is not the anger/rage that is causing the symptoms, rather the guilt and shame that we feel when anger/rage rise up that is causing the conflict of emotions which is causing the symptoms. So, anger arises when my brother tells a sexist joke, I begin to feel angry and hurt, I then feel guilty for feeling anger at my brother because I also love him dearly, so then I feel guilty and ashamed that I felt or expressed anger and then I get …..xyz symptom. I explain this to the patient and then guide/encourage them to feel the anger without the shame/guilt. I help them see that they should not be ashamed for having normal human emotions, or for standing up for themselves. I get them to connect with the hurt, sad part of themselves that is trying so hard and doesn’t deserve to be treated that way. I don’t encourage compassion for the other in the beginning because that is often just taken as more guilt and shame for having the original emotions of anger and shame, but now our therapist/doctor is telling us that our original emotion isn’t “right” or “good”. When the patient seems comfortable with the idea of the guilt suppressing the anger and the anger “just wanting to be seen, acknowledged and felt”, NOT acted out or RAGED OUT, then they are often ready for an ISTDP-type exercise of imagining a past situation when anger was arising and asking them to feel how it feels in their body, where is it? (…my arms are starting to shake, etc.). Then, what does it want to say? and what does it want to do? in the Allan Abbass style. Patients can destroy their abusers in their imagination and that is not dangerous. It can also come out in dreams. The anger wants to just move through the body and once it is out, it is out. I feel that moving to quickly to concepts of “forgiveness” or “compassion” towards the other, the perceived abuse, just works to further repress/suppress difficult to feel emotions like anger.

    in reply to: Marketing materials #2383
    abatsonabatson
    Moderator

    Great idea! We will make one for everyone and post it. If there is a specific information you are looking for to be on it, let me know.

    in reply to: BPPV and crystals #2382
    abatsonabatson
    Moderator

    Celis-Aguilar, E., et al. (2022). “Effectiveness of Brandt Daroff, Semont and Epley maneuvers in the treatment of Benign Paroxysmal Positional Vertigo: A Randomized Controlled Clinical Trial.” Indian J Otolaryngol Head Neck Surg 74(3): 314-321.
    The aim was to compare the effectiveness of Brandt-Daroff, Semont and Epley maneuver in BPPV resolution. A Single Blind RCT in a Secondary Care Center was performed. Inclusion criteria were: patients with unilateral rotatory nystagmus on Dix-Hallpike Maneuver (DHM). Exclusion criteria: other causes of peripheral or central vertigo. Patients were randomized into 4 groups: Brandt-Daroff, “sham”, Semont and Epley. Patients underwent allocation, 1st visit (at 1 week with reprise of original maneuver if persistent nystagmus) and 2nd visit (2 to 4 weeks) with repetitions of both DHM and DHI. Main Outcome Measures: Absence of nystagmus on DHM at 1st and 2nd visit evaluations and DHI score. Resolution was defined as the abscence of nystagmus. We included 34 patients (25 females, 9 males). Patients were randomized to Brandt-Daroff (n = 9), “sham” (n = 7), Semont (n = 9) and Epley (n = 9) group. Overall mean age was 59.85 years (SD +/- 13.10). A total of 47.06% patients (n = 16) had negative DHM at 1st visit. Resolution for Brandt-Daroff was 22.22%, “sham” 28.57%, Semont 44.44% and Epley 88.88% (p = 0.024); at 2nd visit follow up, Epley achieved 100% resolution (other maneuvers: 42.86%, 16.67%, 44.44%, respectively. P = 0.006). The DHI improvement at 2nd visit for Brandt-Daroff was 21.17 points, “sham” 8.05, Semont 14.67 and Epley 61.78 (p = 0.001). Epley maneuver was superior to Brandt Daroff, “sham” and Semont maneuvers on nystagmus resolution and DHI improvement in patients with BPPV.

    in reply to: BPPV and crystals #2381
    abatsonabatson
    Moderator

    Chang, A. K., et al. (2004). “A randomized clinical trial to assess the efficacy of the Epley maneuver in the treatment of acute benign positional vertigo.” Acad Emerg Med 11(9): 918-924.
    OBJECTIVES: To compare the efficacy of the Epley maneuver with that of a placebo maneuver in patients presenting to the emergency department (ED) with benign positional vertigo (BPV). METHODS: This was a prospective, randomized, single-blind placebo-controlled trial. Consecutive adult ED patients presenting to a university teaching hospital with BPV were randomized to treatment with either the Epley or placebo maneuver. The severity of vertigo was evaluated on a 0 to 10-point scale before and after the maneuvers. RESULTS: Eleven patients were randomized to the Epley group and 11 to the placebo group before the trial was terminated, based on a planned interim analysis. The median decreases in vertigo severity were 6 (95% confidence interval [95% CI] = 4 to 9) for the Epley group and 1 (95% CI = 0 to 3) for the placebo group (p = 0.001). CONCLUSIONS: The Epley maneuver is a simple bedside maneuver that appears to be more efficacious than a placebo maneuver in the treatment of acute BPV among ED patients.

    in reply to: Seventy year old woman with Neurologic symptoms #2380
    abatsonabatson
    Moderator

    Very interesting. I would also like to know what happened just before she got the first symptom – the R sided headache while on a “relaxing” vacation. A lot of times patients will present the appearance of everything being “lovely and normal”, but I always want to know what was being talked about, what was said, was were they thinking about just before getting the first symptom. Often times, it is not so “lovely and normal” – comments made, memories arise, thoughts going through your mind, locations and surrounding events – why was she on vacation and with whom? – other triggers that may not be as obvious to the patient, but might be triggering the neural circuits on more sub-conscious levels.

    in reply to: Live Workshop 3 #2281
    abatsonabatson
    Moderator

    I also wanted to say that anxiety is not always something that needs to be regulated – especially when you are trying to work with a therapist. I think our job is not to regulate it – in a way, that is repression – I think we need to understand what is causing it and to do that, we have to allow it to be for the moment. The rising of anxiety is a sign the danger signal has been turned on. We can use that to explore why that is – what was the thought, the emotion, the thing that was said or done or not said or not done or seen – that made the danger signal sense danger? If we focusing on repressing the anxiety we might miss the opportunity to see what is underneath it. Of course, if the patient’s anxiety is too high, you can’t do the work either….so regulation is necessary. It is an art to know when to help the patient regulate and when to help them explore it.

    in reply to: Live Workshop 3 #2280
    abatsonabatson
    Moderator

    Hi Aaron,
    Ditto on everything Howard said.
    I would not consider a rising of anger as something to avoid or something that went wrong. I would view it as great material to work with and to begin to crack the egg, the hard shell of his emotions. My suspicion is that weakness and vulnerability led to lack of safety in his experience – perhaps, he was ridiculed for his empathy, made fun of, got in trouble in some way, mocked or beat up. I wonder if he can remember a time when he had a similar feeling in the past. Sometimes abusers will look for a persons weakness or try to elicit it and then pounce with they see it – like a tiger seeing blood. Next time you see him, it might be helpful to revisit the situation, see if anger arises again, ask him where he feels that anger in his body, ask him if it has a voice, what it wants to say, what it wants to do, etc.
    I thought you did a great job.
    Alicia

    in reply to: Validation, Hope and Understanding #2237
    abatsonabatson
    Moderator

    In fact, I think some patients aren’t really ready to hear there is even HOPE ! After all they have been through, how could there be? and if there were any hope at all, wouldn’t that mean that they had needlessly suffered? And, if they had needlessly suffered, that could, of course, be ENRAGING and too much to bare. I had a friend who had been in chronic neck pain for many years resulting in an early retirement and disability; after explaining the paradigm to her, her first question was, “What would I do about my disability?”. Sometimes, patients have gone so far down the rabbit hole of pain and it has become the whole focus of their lives, it is hard to even imagine extricating yourself out of that.

Viewing 15 posts - 1 through 15 (of 33 total)