Relaxation Techniques

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Progressive Relaxation

The method involves learning to relax by first tensing and then relaxing different muscle groups in the body. Briefly tensing muscles makes it easier to experience the contrast between a tensed and a relaxed muscle, and to notice tension in various muscles during daily activities. The different muscle groups that are included can be conceived of as a menu from which patients can choose. There is absolutely nothing sacred about the constellation of muscle groups. The important thing is that as patients achieve a high degree of relaxation, they need not always follow the PR instructions to the letter. For some patients the tensing releasing of a certain muscle group can lead to an experience of increased tension in that muscle. If that is the case, that particular muscle group may be deleted from the relaxation training. Progressive relaxation training begins with demonstrating to patients exactly how the different muscle groups are to be tensed and relaxed. The therapist sits opposite...

Releaseonly Relaxation

Below is an example of the instructions used in this phase Breathe with calm, regular breaths and feel how you relax more and more with each breath Just let go Relax your forehead eyebrows eyelids jaws . tongue and throat . lips . and your entire face Relax your neck . shoulders . arms . hands . and all the way out to your fingertips Breathe calmly and regularly . and let the relaxation spread to your stomach . waist and back Relax the lower part of your body, your buttocks . thighs . calves . feet . and all the way down to the tips of your toes Breathe calmly and regularly and feel how you relax more and more with each breath Continue to relax like that for a while Pause for about 1 minute. Now take a deep breath, hold it . and let the air out slowly . slowly . Notice how you relax more and more.

Differential Relaxation 1 Introduction to Differential Relaxation

In order for AR to be an effective coping skill it must be portable, The patient should be able to use it in practically any situation and not be constricted to a comfortable armchair in the home or in the therapist's office. The primary purpose of differential relaxation (DR) is to teach the patient to relax in other situations besides in the comfortable armchair. The secondary purpose of DR is to learn not to be tense in the muscle groups not being used for the activity at hand.

Introduction to Rapid Relaxation

The purposes of rapid relaxation (RR) are to teach the patient to relax in natural but not anxiety-arousing situations, and to further reduce the time it takes to become relaxed. The goal for this is 20-30 seconds. In order to reach these goals the patient should use rapid relaxation 15-20 times a day in natural situations. At this stage it is very important that the therapist spends some time to thoroughly go over the goals with the patient and to write down suitable situations that function as signals for RR training. The therapist asks the patient to describe what an ordinary day looks like to them and what they do between getting out of bed in the morning through going to bed at night. Among those activities that the patient does one can choose signal situations in such a way that it make up at least 15 practice occasions per day.

Instruction of Rapid Relaxation

When the patient is relaxing in natural situations during this phase of AR the relaxation has largely been reduced. The patient is instructed and the therapist models the following sequence If, after doing all the above, the patient still feels that they haven't achieved a deep enough degree of relaxation, one can take one more deep breath as described above. In some cases the entire sequence can be repeated for a third time. After this the patient should be content with the degree of relaxation achieved. Otherwise there is a risk that the patient will trigger symptoms of hyperventilation, which of course counteracts the purpose of RR.

Relaxation Enhancement

Biological tissues are associated with characteristic relaxation time constants T and T2, which reflect processes of longitudinal and transverse relaxation (often referred to as spin-lattice and spin-spin relaxation, respectively). These relaxation time-constants may indeed be directly interpreted as indicative of the nature of the microenvironment longitudinal relaxation is facilitated by (although not solely by) the presence of macromolecular or microstructural entities - hence water proton Tj may be short in white matter, and rather longer in cerebrospinal fluid in which such moieties are less prevalent. Similarly, spin-spin relaxation rates are facilitated by interactions between protons of water molecules. In the cerebrospinal fluid (CSF) environment, such interactions are brief in duration and so remain relatively ineffective (leading to a rather long T2 value). By comparison in more physically constrained biological tissues, in which interactions are more pronounced, the T2...

Relaxation Therapies

Since the late 1950s a host of formal relaxation therapies including progressive muscle relaxation training, autogenic training, imagery training, biofeedback, and hypnosis have all been used to treat insomnia. Common to these approaches is their focus on such factors as performance anxiety and bedtime arousal, which often perpetuate sleep difficulties. Regardless of the specific relaxation strategy employed, treatment entails teaching the insomnia sufferer a formal exercise or set of exercises designed to reduce anxiety and arousal at bedtime so that sleep initiation is facilitated. Typically multiple weekly or biweekly treatment sessions are required to teach relaxation skills that the patient is encouraged to practice at home in order to gain mastery and facility with self-relaxation. The goal of all such treatments is that of assisting the insomnia sufferer in achieving sufficient relaxation skills so that insomnia resulting from sleep-related performance anxiety and bedtime...

Relaxation in the presence of intercalators

Another way to think of the effect of intercalators is to consider relaxation of DNA in the presence of ethidium bromide. Consider a topoisomer of'relaxed' pBR322 DNA (Lk Lkm +415, Tw +415, Wr 0) addition of ethidium bromide causes an untwisting of the DNA by, for example, eight turns (Tw +407) (Figure 2.18). The molecule must hence adopt an equivalent positive writhe (Wr +8). Treatment of the sample with a topoisomerase leads to relaxation of the DNA under the changed conditions (added inter-calator, reduced twist), that is Wr 0, Lk +407, Tw +407.4 Subsequent removal of the ethidium bromide causes an increase in twist and the appearance of negative writhe that is, the molecule becomes negatively supercoiled under the original conditions (e.g. Lk +407, Wr -6, Tw +413). This procedure is commonly used for the preparation of negatively supercoiled DNA of any required average specific linking difference such as those in Figure 2.15 relaxation under conditions of increasing ethidium...

Relaxation Techniques

Relaxation is different from leisure. Leisure activity is an important way to achieve balance. Physicians will find the stressors of leisure enjoyable in part because they are so different from the common stressors of professional life. Leisure activity will also usually involve family and friends. However, leisure activity frequently contains stressors of its own that tend to arouse and fatigue, rather then renew. Relaxation is different from doing nothing. Relaxation actually increases awareness and focuses the mind while resting the body. It is a time to be present, to reflect, and to process experiences and feelings. Systematic relaxation requires concentration and deliberate mental activity. It will lead to lower arousal and release of strain. It can be particularly helpful if the relaxation does not require physically leaving the home, e.g., pleasure reading, gardening, hobbies, and crafts. For those finding it difficult to achieve this level of relaxation, many techniques are...

Fractons and Vibrational Relaxation in Proteins

In his book on random walks, Howard Berg makes the memorable statement Biology is wet and dynamic (Berg, 1983). Indeed, biochemical processes are inextricably linked to the solution chemistry of the aqueous milieu. One might anticipate a continuum description, as given in Chapter 5, as being the most appropriate for the diffusive processes of biochemistry. There is, nevertheless, considerable interest in discrete or jump transport processes. Such processes often provide a convenient mathematical limit for studying continuum events. However, discrete models are more than mathematical devices. The starting point for the formulation of vibrational relaxation in complex media are differential-difference equations. These equations have a rich phenomenology and can give rise to complex oscillatory and chaotic processes. The focus of the present chapter will be on vibrational processes in proteins. There are a number of other biological settings that are appropriately described by jump...

Relaxation And Tissue Contrast

The process wherein the magnetization returns to its equilibrium configuration parallel to B0 is known as nuclear spin relaxation. Typically, relaxation is conceptually separated into two separate processes (i) relaxation of the magnetization component that is parallel to B0 and (ii) relaxation of the magnetization component that is transverse to B0. The former is known as longitudinal or T1 relaxation, and the latter is known as transverse or T2 relaxation. Relaxation derives its energy from the random rotational and translational motion of the water (or lipid) molecules within the tissue. These motions are constrained by the tissue ultrastructure. It has not been possible to develop an exact theory of nuclear magnetic spin relaxation relevant to tissue due to the complex nature of the tissue ultrastructure. However, theories developed for simpler homogeneous materials can be extended to describe tissue nuclear spin relaxation. Moreover, tissue nuclear spin relaxation characteristics...

Theoretical Basis For Applied Relaxation

Since there are no studies regarding the mechanism of change for AR at this time one can only speculate concerning this issue. Personally, I believe that AR works through the patient having acquired the skill to rapidly achieve a state of relaxation, which counteracts the anxiety reactions both on a physiological and a cognitive level. Perhaps Bandura's self-efficacy theory can be used in this regard. There are at least three contributing factors which cannot be disregarded 3. Increased self-confidence. By using the relaxation skill in natural situations and noticing that it works, one can reduce or abort the anxiety altogether. The patient develops an increased confidence in their own ability to do something proactive. The patient is no longer a helpless victim of panic.

Instruction of Differential Relaxation

Continue to relax as much as possible in the entire body. While you do that open your eyes and look around in the room without moving your head. Look to your left . and to your right . up to the ceiling . and down to the floor. Concentrate on relaxing as much as possible in the rest of the body Now do the same thing but also turn your head in order to take in a larger field of vision. Look to the left and to the right up to the ceiling and down to the floor. Good Take the head back to a comfortable position and relax as much as possible. Let your arms rest against the elbow rests and now lift the right hand a bit from the support. Concentrate on the relaxation in the left hand and arm . now stretch the arm straight out . and straight up in the air . focus on the relaxation in the left arm . and now take the right arm back to a comfortable position on the armrest. Relax as much as possible in your right arm and do the same thing with the left arm. Lift the left hand a little bit from...

Cue Controlled Relaxation

The purpose of cue-controlled relaxation (CR) is for the patient to learn to associate the self-instruction relax with a relaxed state, and further reduce the time it takes to become relaxed. Cue-controlled relaxation may be introduced to patients as follows Most of us have probably been in situations where we or an acquaintance have been very nervous. In that situation we often get the advice to 'take it easy and relax.' This advice very seldom works since it is given when we are already mentally and physically at a high arousal level. In order to relax in these situations you must practice pairing the relax self-instruction with the relaxed state. Once you can successfully make yourself relaxed, you then need to start practicing this cued relaxation in increasingly more stressful settings. The session starts by the patient relaxing on their own with the help of the release-only version of PR, which the patient has been practicing for 1-2 weeks. When having achieved a deep degree of...


First, the protons slowly (on the time scale of seconds for most brain tissue) realign with the main magnet. This is called longitudinal relaxation, and the time constant associated with this exponential process is called T1. Second, the signal generated by the collection of precessing protons is weakened by the

Relaxation exercises

Anxiety increases when dyspnea increases. Previously this has been primarily a clinical observation with anxiety increasing with increasing shortness of breath in a synergistic spiral resulting in severe shortness of breath and panic. Recently anxiety has been associated with increasing or high dyspnea in a controlled trial of asthma patients in an emergency room,63 in COPD patients during treadmill exercise64 and in cancer patients.8 Since they are related, strategies that decrease this anxiety or modulate the level of distress might be expected to reduce dyspnea. Relaxation may have a physiological effect by reducing respiratory rate and increasing tidal volume, thus improving breathing efficiency and dyspnea.65 One investigator studied the effect of relaxation on dyspnea in 10 patients with COPD compared with a control group that was instructed to relax, but not given specific instructions. Although dyspnea was significantly reduced for the relaxation group during treatment...

Empirical Support Of Cbt For Addictive Behaviors

Replacement behaviors, and changing the relationships between cognitive distortions and physiological arousal and gambling. The investigators used relaxation training, imaginal and in vivo exposure, and cognitive restructuring as primary modalities. Following treatment the client showed a significant decrease in frequency and intensity of gambling impulses. With the exception of placing a single bet, the client did not gamble for 10 months. Additionally, the client reported a decrease in anxiety based on the Beck Anxiety Inventory.

Theoretical Basis

AMT is based on Richard Suinn's suggestion that clients can be taught to identify the internal signs, both cognitive and physical, that signal the presence of anxiety and to react to those signs by engaging in responses that remove them. This formulation was based on learning theory that conceptualized anxiety as a drive state and postulated that behaviors could be learned to eliminate the drive. Anxiety was viewed as having both response and stimulus properties. It was a response to prior internal and or external anxiety-arousing stimuli. Its stimulus properties involve the potential to elicit new responses such as avoidance and escape. As such, it was argued that anxiety's stimulus properties could become associated with new responses, such as coping responses. AMT, therefore, does not require clients to identify the stimuli that precipitate their anxieties. Instead, the experience of anxiety itself is used to train the client in coping. The goal is to provide the client with a...

Anaesthetic Emergencies

After loss of consciousness, suxamethonium is administered. Maximal relaxation occurs after the fasciculations have ceased and this is when the trachea should be intub-ated. The cuff is sealed and then cricoid pressure is released. Ventilation proceeds as usual. The entire procedure should take between 30 and 90 s with adequate preoxygenation this should not produce serious hypoxaemia.

Cognitivebehavioral Therapy Interventions For Anger Problems

Problem and an agreement for treatment procedures and goals. Self-monitoring is often used in conjunction with techniques such as relaxation training, cognitive restructuring, problem solving, and social skills training in order to track progress in using new skills outside of therapy sessions. Relaxation training teaches clients to monitor levels of arousal and to use a variety of methods for lowering arousal in order to increase their ability to cope physiologically or emotionally during anger-provoking situations (Deffenbacher, 1999). Two useful interventions are auto-genic relaxation training and progressive muscle relaxation. Autogenic relaxation training is useful when a quick and easy method for achieving relaxation is needed. However, progressive muscle relation may be more helpful when clients are not aware of their general level of physiological arousal and cues for anger outbursts. Relaxation training is a basic component of the stress inoculation protocols that have...

Clinical Evaluation

Closed reduction of posterior simple elbow dislocations can be achieved in some cases even without anesthetic, but this is not advocated, because pain relief and muscle relaxation prevent further injuries during reduction. Also, the assessment of stability after reduction with the patient under anesthetia is much easier and more reliable.

The Nature Of Cognitivebehavioral Interventions

A number of varied interventions have been employed with individuals with anger-control problems including relaxation-based interventions, systematic desensitization, behavioral skills training, adjudicated psychoeducational counseling programs, rational-emotive behavioral therapy, and cognitive-behavioral programs, such as self-instructional training, stress inoculation training, problem-solving interventions, and exposure-based procedures. The CBT interventions are usually short-term (8 to 22 sessions) and may be conducted on an individual and or group basis. The average length of treatment in various outcome studies was 12 sessions. The research indicates that on average individual treatment is more effective than group treatment. But this conclusion should be treated as preliminary given the limited number of such comparative outcome studies. A major finding of the meta-analyses was that programs that used standardized treatment manuals and that conducted treatment fidelity checks...

Alternative Methods Of Closedchest

Compression of the abdomen during cardiac arrest generates aortic pressures similar to chest compressions. The hypothesis that CPR diastolic aortic pressure and venous return from the abdomen might be augmented by abdominal compressions led to the idea of IAC CPR. One person performs the chest compressions of standard CPR while another person applies a similar compression over the central abdomen during the relaxation phase of chest compression. The hemodynamic effects of IAC CPR in laboratory investigations have not been consistent, but most have shown increases in CPR diastolic aortic pressure, coronary perfusion pressure, and cardiac output. Results of clinical studies of IAC CPR have been highly variable. Some studies have shown no evidence of improved resuscitation outcome, whereas others have demonstrated significant improvements in ROSC and survival to hospital discharge.2 Differences in study populations and the technical performance of IAC CPR may be the reasons for the...

Cognitivebehavioral Therapy For Anxiety Disorders

Cognitive-behavioral treatments for anxiety disorders generally directly target the hypothesized causal and especially maintaining factors. Treatment usually focuses on physiological, behavioral, and cognitive responses of anxiety. There are a number of manualized treatment packages that have been developed to target specific anxiety disorders, and these have generally been shown to be quite effective in reducing or eliminating the symptoms of the targeted disorder. The treatments vary somewhat depending on the anxiety disorder, but most share many common features including the use of exposure, cognitive challenging, relaxation, and psychoeducation.

Introduction to Application Training

The only rationale you give the patient at this stage is that it is now time to start practicing in reality what they have learned in theory. Before starting this phase it is very important to give the patient an instruction that sets their expectations at the right level. You remind the patient that applied relaxation is a skill and as with any other skill it takes practice to refine it. This means that the patient should not expect that AR functions at 100 the first time it is applied, such as with a panic attack. Instead, one must be satisfied with the anxiety not increasing as much as it had before, but that it levels out at a mild to moderate level. It is very important that the patient does not get demoralized but that they continue to apply AR every time they are in an anxiety situation. Relatively soon one will notice an effect from AR, and eventually the anxiety reactions will dissipate altogether. Before the patient goes out into real life situations and starts applying the...

Cognitive Behavior Therapy

Cognitive-behavioral treatment for anxiety disorders in children, as pioneered by Philip Kendall and his colleagues (1992), serves as a prototype of these newer interventions. It is focused on both cognitive and behavioral components. Cognitive strategies are used to assist the child to recognize anxious cognition, to use awareness of such cognition as a cue for managing anxiety, and to help them cope more effectively in anxiety-provoking situations. In addition, behavioral strategies such as modeling, in vivo exposure to the anxiety cues, role-play, relaxation training, and reinforced practice are used. A workbook is typically provided to the parents and the child and weekly monitoring of gains is pursued. Thus, the cognitive-behavioral procedures are broad in scope and incorporate many of the elements of treatments used historically with phobic children.

Control of Oxygen Consumption

The control of Vo2 is important in restoring the balance of oxygen supply and demand to tissues. A hyperadrenergic state results from the compensatory response to shock, physiologic stress, pain, and anxiety. Shivering frequently results when a patient is unclothed for examination and then left inadequately covered in a cold resuscitation room. The combination of these variables increases systemic oxygen consumption. Pain further suppresses myocardial function, thus impairing D o2 and Vo2.15 Providing analgesia, muscle relaxation, warm covering, anxiolytics, and even paralytic agents, when appropriate, decreases this inappropriate V o2. It is also important to provide appropriate anesthesia analgesia for invasive procedures, since this is many times inappropriately forgotten in the haste of expedient intervention.

Spontaneous Breathing

While oropharyngeal (Guedel) or nasopharyngeal airways are satisfactory (and sometimes essential) the laryngeal mask airway has virtually replaced them. One reason is the ease with which it is possible to maintain the airway with no hands, freeing the anaesthetist to deal with other tasks. The LMA also provides, in most patients, a better and more secure airway. Provided the depth of anaesthesia and muscular relaxation is appropriate for the surgery regurgitation of gastric contents and their aspiration into the trachea should be no more common, and perhaps even less common, than with other airways. Should artificial ventilation become necessary it can be readily commenced and maintained.

Dynamic Contrast Enhanced MRI

For both T1 and T2* approaches, it is possible that improvement in quantitation can be achieved by converting signal intensity changes observed directly on MRI into dynamic changes of contrast agent concentration to provide the source data for descriptive or kinetic modeling2 (Schwickert et al. 1995 Roberts 1997). In contrast to nuclear medicine and CT, signal changes in MRI are not directly related to tracer concentration, in vivo. Common practice is to convert observed signal intensities into local changes in the pertinent relaxation rate (1 T1, or 1 T2*). The implied assumption subsequently is that contrast agent potency (or relaxivity, r1 or r2* - the amount of relaxation enhancement per unit concentration of tracer) is the same across all tissues and compartments. This assumption is likely to be flawed in vivo, and may be especially inappropriate for transverse relaxivity, r2*, where local magnetic susceptibility field gradients are a function of local compartmentalized...

Nonpharmacologic Modalities Cognitive Behavioral and Physical Therapies for Analgesia and Anxiolysis

Traditionally, nonpharmacologic techniques of pain management in the ED are limited to application of heat or cold, and immobilization and elevation of injured extremities. Other techniques may prove to have a role in the ED and post-ED setting. Among these are cognitive-behavioral techniques, which are effective in reducing pain and anxiety, may control mild pain when used alone, and also enhance patient satisfaction. These techniques include reassurance, explanation, relaxation, music, psychoprophylaxis, biofeedback, guided imagery, hypnosis, and distraction. They are a useful adjunct to pharmacologic management of moderate to severe pain.1 Successful application of these therapies requires a cognitively intact patient and skilled personnel, but many of the techniques require only a few minutes to teach the patient.

Description Of Treatment

Assertion training usually consists of a variety of components, including instruction, model presentation, behavior rehearsal, feedback, programming of change, and homework assignments. Other procedures that may also be used, depending on what is found during assessment, include self-instruction training, relaxation training, cognitive restructuring (e.g., decreasing unrealistic expectations or beliefs), and interpersonal problem-solving training (helping clients to effectively handle challenging situations that arise in social situations such as reactions of anger that get in the way of maintaining friendships). Written material may be used to provide instructions and to clarify differences among aggressive, assertive, and passive behaviors in a situation. For example if you believe you have been treated unfairly by a professor, you could appropriately speak to your instructor about your concerns (be assertive), say nothing (be passive), or yell at the instructor (be aggressive)....

Future Directions

Perhaps the most neglected but potentially useful CBT intervention procedures involve the use of relaxation techniques in concert with cognitive structuring. It is not uncommon that the comorbidity of ASD and Anxiety Disorder is not detected addressed, given the extreme behavior outbursts and the relative social isolation presumed to be simply a characteristic of ASD. Since social situations may increase the level of anxiety in general for individuals with ASD, this is particularly problematic because a primary goal of therapy is often to improve social interaction. The use of relaxation and or diaphragmatic breathing in combination with CBT has proven useful for individuals with anxiety and related disorders. Application to individuals with ASD would appear to be a promising direction (Luscre & Center, 1996). However, systematic controlled outcome research for CBT with individuals with ASD is currently lacking, but there is increasing interest and activity in the clinical...

Sexual Performance Motivation And Stimulation Of Males

Within a species, motor patterns associated with courtship and copulation are species-specific and relatively invariant, although the sequence of behaviors exhibited varies within and among individuals. Large variation in the frequency or intensity of displays of sexual behavior does occur in farm animals and is likely due to relaxation of natural selection. 2,3 For example, single-sire mating systems enable animals with poor sexual performance to produce large numbers of offspring. This would not occur normally in wild animals, because competition among males would continue to exert intense selective pressure for high sexual performance. The number of males displaying inadequate sexual performance is significant, and this lack of performance has direct economic consequences.

Low Resolution Nuclear Magnetic Resonance

When a sample containing magnetic nuclei such as hydrogen protons is placed in a static magnetic field, B0, the nuclei align with the field and a bulk nuclear magnetisation develops. This process occurs exponentially in a characteristic time T1( the spin lattice relaxation time such that Variations in Bloc cause different nuclei to precess at different rates and the initial coherence of the nuclear magnetisation is lost. With the loss of coherence (dephasing) goes the loss of observed signal. For all but the very fastest decays which usually exhibit complex decay functions, this generally occurs exponentially in a characteristic time T2, the spin-spin relaxation time so that

Recommended Readings

R., & Groden, J. (1978). Relaxation A comprehensive manual for adults, children, and children with special needs. Champaign, IL Research Press. Steen, B. E., & Zuriff, G. E. (1977). The use of relaxation in the treatment of self-injurious behavior. Journal of Behavior Therapy and Experimental Psychiatry, 8, 447-448.

Conclusion and Limitations

In conclusion, valuable contributions to the quality of patient care can be made by applying standard information technology. While a system like Telebaby cannot replace the skin-to-skin contact of a baby with his or her caregivers, it nonetheless contributes to the relaxation of the parents. Spitz (1945) would surely agree that such a system can only be favorable for the hospitalized newborn's well-being. With health care moving toward a much more patient-orientated approach, we suggest that a relatively simple and low-cost application such as Telebaby can also contribute to the well-being of the caregivers and thus of their newborns.

Effects on the Cardiovascular System

Caffeine decreases peripheral resistance by direct vasodilatation and increases blood flow to a small extent. This effect results from the relaxation of smooth muscle of blood vessels. For coronary arteries, vasodilatation is also observed in vitro, but the effects of caffeine in human coronary arteries in vivo are unknown. Different effects of caffeine on circulation can be observed in different vascular beds and, for example, the treatment of migraine headaches by caffeine is mediated through the vasoconstriction of cerebral arteries. It has also been shown that caffeine is capable of attenuating postprandial hypotension in patients with auto-nomic failure.

Effects on the Respiratory System

In caffeine-naive subjects, a dose of 4mgkg_1 increases the mean respiratory rate. This effect is not found in chronic caffeine ingestion. Several mechanisms have been suggested, such as an increase in pulmonary blood flow, an increased supply of air to the lungs due to the relaxation of bronchiolar and alveolar smooth muscle, an increase in sensitivity of the medullary respiratory center to carbon dioxide, stimulation of the central respiratory drive, an improved skeletal muscle contraction, and an increase in cardiac output.

The A Wave X Descent C Wave and X Descent

Atrial relaxation produces the drop in pressure known as the X descent. Atrial relaxation produces the drop in pressure known as the X descent. Note Only a minority of cardiologists name this descent, and most of those who do name it call it X, i.e., they give it the same name as that given to atrial relaxation, thus leading to great confusion 1 .

The V Wave and Y Descent

Most authors use the letter X to name both atrial relaxation and the fall in pressure due to the descent of the base, thus making the physiology of jugular contours difficult to understand. ANS Right ventricular relaxation allows RV pressure to fall below right atrial pressure, thus opening the tricuspid valve (at the end of isovolumic relaxation).

On Line Instrumentation

The required length of the magnet is determined by the speed of the production line and by the relaxation times Tj and T2. For a sample with a spin lattice relaxation time of 1.0 s and a production line moving at 0.2 m s, a polarising magnet 0.6 m long is needed in order to produce an initial magnetisation which is 95 (three decay constants) of maximum. If the sample T2 is 0.5 s then in order to see two decay constants of the FID the subsequent measurement magnet will need to be a further 0.2 m long. To this must be added the length of the product, say 0.2 m, giving a total length of 1 m. One large magnet may be used. If two separate magnets are used, the first can be of much lower homogeneity and can be set at a higher field strength so as to increase the magnetisation polarisation

Background and Significance

(AHCPR) to develop recommendations for colorectal cancer screening. There were five important conceptual innovations that resulted from their proceedings. The first was the relaxation of the stringent evidence-based criteria. Instead of directly linking a specific modality to the existing evidence for screening, it was accepted that if the early detection of cancer reduces mortality any procedure that reliably detects colon cancer could be assumed to be effective as well. This allowed for the second major change, the consideration of the double-contrast barium enema and colonoscopy for the general population. Integral to the proposal of such increasingly invasive and expensive procedures was the understanding that screening is not intended to be a one-time event but rather a long-term program of repeated application. If such tests are more thorough and can be performed at prolonged intervals, it minimizes their negative features. Thus, this panel became the first to incorporate...

Deidre Donaldson and Dennis Russo

One of the central uses of biofeedback from a cognitive-behavioral point of view is to promote the acquisition of self-control training or self-regulation skills. For example, in behavioral medicine, the use of biofeedback assists the clinician in monitoring and guiding treatment involving relaxation

Contemporary Uses Of Biofeedback

Electromyogram biofeedback involves sensors that measure skeletal muscle tension, particularly in the frontalis (forehead), masseter ( jaw), and trapezius (upper back). Increased electrical firings indicate increased tension (Basmajian, 1989). The goal of EMG biofeedback is to learn to be aware of the cues of muscle tension, avoid escalating tension, and deescalate or reverse tension through the use of certain skills (e.g., progressive muscle relaxation). Thermal biofeedback assesses changes in skin temperature, which indicate changes in blood flow as well as the autonomic nervous system more generally as constriction is related to stress activation. EEG biofeedback measures electrical action of the cortex and translates it into frequencies and amplitudes yielding different types of brain waves (Basmajian, 1989). Changes in brain waves provide information about arousal level and attentiveness. Other commonly used modes include heart rate, blood pressure, and respirations (PNG or...

Transfer of the Head Injured Patient

Head injured patients and those with suspected intracranial haemorrhage may require transfer between hospitals for either CT scanning or definitive management of their injuries. This can be a difficult and dangerous enterprise and should be carried out with the greatest of care. Facilities in ambulances, helicopters and scanning rooms are limited, as is space, but nevertheless the management of the airway and ICP must take precedence over speed or convenience. The patient must be stabilised before transfer. The escort must be capable of managing the predictable eventualities re-intubation, hypertension, hypotension and, thus, must take with them sufficient equipment, drugs and fluids to maintain anaesthesia and relaxation. Ambulances should be able to travel quickly but smoothly without the severe shocks of fast travel. Monitoring should include automatic blood pressure, pulse oximetry and preferably end tidal CO2 measurement. For CT scanning, there must be appropriate equipment in...

Color And Food Importance Of Food Color

The psychological effects of color have long been recognized. A room decorated in red exudes warmth and may increase pulse and respiration rates and even increase vivacity. Whereas a room decorated in blue or green is cool and peaceful encouraging concentration and relaxation. But darkening that blue can turn it into a subdued and even depressing atmosphere. The color of food also has its psychological aspects but these are less of mood swings than they are of learned associations. The color of a food not only sends a message of expectation but can also provide clues as to the condition of that food a yellow peach is ripe, brown strawberry jam is old. Food of an unnatural color raises a barrier that most people have difficulty overcoming. Witness the red-fleshed potato that cooks up blue. Most people given the chance will avoid tasting it even when assured it tastes similar to the familiar white varieties. In contrast a recently introduced yellow-fleshed variety, reminiscent of...

Biochemical Interactions Of Actin And Myosin

As in striated muscle, contraction and relaxation of smooth muscle are regulated by changes in the amount of cytosolic calcium available to interact with the regulatory protein. In relaxed muscle, the level of free As in striated muscle, cytoplasmic free calcium must be decreased to allow for relaxation. In those cells with abundant SR, most of this calcium is pumped back into the SR via a calcium ATPase. However, in these cells, and especially in those cells with little SR, calcium must also be expelled from the cell across the cell membrane. Presumably, this is accomplished by a sodium-calcium exchange mechanism and perhaps by a membrane-bound calcium ATPase. Smooth muscles vary in the electrical events exhibited by their cell membranes. During relaxation, all are polarized, exhibiting resting membrane potentials of 40 to 80 mV. The basis for this potential is primarily the same as in striated muscle (Fig. 4). In many smooth muscles the membrane potential in relaxed cells is not...

Mechanical Response Of Smooth Muscle In Vitro

FIGURE 9 Recordings of isometric forces from a tonically active (A) and a phasically active (B) smooth muscle. The dashed lines indicate 0 force when the muscles are relaxed completely. Gm indicates that the force is measured in grams. Note that, during the time of these recordings, the tonic muscle never relaxed, while the phasic muscle went through two cycles of contraction and relaxation. FIGURE 9 Recordings of isometric forces from a tonically active (A) and a phasically active (B) smooth muscle. The dashed lines indicate 0 force when the muscles are relaxed completely. Gm indicates that the force is measured in grams. Note that, during the time of these recordings, the tonic muscle never relaxed, while the phasic muscle went through two cycles of contraction and relaxation.

General Surgery Laparotomy

The majority of patients requiring laparotomy will present an aspiration risk and, therefore, require rapid sequence induction and subsequent muscular relaxation with intermittent positive pressure ventilation (IPPV). In the case of a perforated viscus (duodenal ulcer, for example) electrolyte imbalance, dehydration and cardiovascular instability make for a high risk procedure. The presence of faecal soiling of the peritoneum is a particularly bad prognostic indicator. Anastomosis of the bowel requires special consideration. Survival of anastomoses is maximised if the blood supply to the joined section is not compromised in any way. In practice, this requires the avoidance of reversal drugs (and, therefore, atracurium is indicated) and the use of epidural anaesthesia, usually combined with general anaesthesia if there are no contra-indicating factors to the technique (such as poor haemodynamic resuscitation). Epidural anaesthesia provides better post operative pain relief than patient...

Transurethral Resection of Bladder Tumour TURBT

Bladder tumours are not usually large and rarely result in major blood loss. Occasionally patients will be anaemic at presentation from frank blood loss over a period of time. Anaemia should be corrected. Use of diathermy in the bladder can stimulate the obturator nerve, which is close by in the pelvis, lateral to the bladder. This causes mass movement of the patient's legs which can result in perforation of the bladder and vascular or bowel damage by the resectoscope. This situation can only be prevented by using muscular relaxation and IPPV. Good relaxation is also necessary for adequate bi-manual surgical assessment of the tumour and the bladder, anaesthesia should not be terminated until this is complete. Patients with bladder tumours become regular attenders and so at each attendance the anaesthetist must establish the time since the last general anaesthetic, which agents were used and the patient's response to them. As time passes new medical conditions may appear or...

Patient Selection And Technique

The evaluation of patients with ascitic fluid collections should be as rigorous for laparoscopic procedures as those performed for major surgical resections. As stated above, general anesthesia is frequently required because of the need for performance of pneumoperitoneum, abdominal relaxation and length of intraabdominal examination required to avoid missing small occult lesions. Assessment of cardiac and pulmonary function is important to avoid post-procedure complications. Radiographic evaluation of the chest is mandatory to determine whether pleural effusion is present along with abdominal fluid collections. Diagnostic or therapeutic thoracentesis should be performed when necessary with full radiologic evaluation afterward to insure that pneumothorax has not resulted. Pre-laparoscopic determination of coagulation abnormalities, especially in patients with underlying hepatic disease is important. Assessment of prothrombin time and partial thromboplastin time as well as platelet...

The effect of solution conditions on supercoiling

The average value of linking number obtained on relaxation depends on the solution conditions under which the relaxation reaction took place. There are two well-studied conditions that have an effect on the helical repeat (and hence on the twist) of double-stranded DNA the availability of positively charged ions (counterions) to neutralize the negatively charged backbone of the DNA, and changes in temperature. Figure 2.12 The effect of counterions on the relaxation of closed-circular DNA. An agarose gel illustrating the effect of relaxation of DNA in the presence of varying concentrations of Na+ and Mg2+. After relaxation, the samples were electrophoresed together under conditions of low counterion concentration. In general, increasing concentrations of counterions lead to relaxation at increasing values of Lk , which is manifested on the gel as increasing positive supercoiling oc open-circular (nicked) DNA L linear DNA. See text for further details (reproduced from ref. 25). Figure...

Calcium Activation Mechanisms

Various hormones and drugs activate plasma membrane receptors to elicit an increase in cytosolic calcium. Increases in cytosolic calcium occur through a combination of enhanced calcium entry from the extracellular environment and mobilization of calcium from internal stores however, the relative contributions of these two pathways can vary. Increases in calcium entry occur through a variety of pathways including receptor-operated channels, second messenger-operated channels, stretch activated channels, and voltage-dependent channels that are activated upon membrane depolarization. Depolarization results from influx of sodium and calcium following activation of receptor-operated cation channels, activation of chloride channels, or inacti-vation of potassium channels. Decreases in net calcium entry occur following dissociation of ligands from their receptors or as a consequence of membrane hyperpolarization, such as occurs when membrane potassium channels are activated. Several...

Pelvic Floor Muscle Feedback for Incontinence and Vulvodynia

A similar application has strong scientific support the retraining of pelvic floor muscles using a vaginal or anal EMG sensor. Feedback from the pelvic floor muscles can help the physical therapist and physician diagnose problems such as muscle weakness, spasti-city, or poor motor control. Then exercises using visual displays of muscle activity are designed and practiced until mastered. This is another rehabilitation model use of biofeedback, but it appears that the feedbackassisted exercises improve motor control and this leads to a series of positive gains for urinary incontinence or painful intercourse (vulvodynia). A similar application can be used for fecal incontinence. The patient can often regain control of his or her bowel function in a few sessions using an anal probe pressure device with instructions to normalize the pattern of contraction and relaxation of the anal sphincters.

Contrast Agent Relaxivity

Provided that the BMS shift is negligible, the relationship between relaxation rate (1 T and 1 T2) and contrast agent concentration can be predicted by the Solomon-Bloembergen equations (Gowland et al. 1992) where r1 and r2 are the spin-lattice and spin-spin relaxivity constants respectively and T10 and T20 are the spin-lattice and spin-spin relaxation times respectively in the absence of contrast material. These relationships have both been confirmed in vitro (Rosen et al. 1990 Donahue et al. 1994 Judd et al. 1995) and for T in vivo (Wedeking et al. 1992) across a range of concentrations. These expressions allow theoretical predictions to be made about the influence of a contrast agent, such as Gd-DTPA, on signal intensity. Relaxivity is dependent upon field strength and the chemical structure of the contrast agent (Springer 1994). While it is normally assumed that the physico-chemical nature of the tissue has little affect upon contrast agent relaxivity, there is strong evidence...

Measurement of Contrast Agent Concentration In Vivo

Spin-spin relaxation rates of tissues it should be possible to infer their distribution by observing the influence on the MR signal. Since the concentration of Gd ions is known to be directly proportional to the change in 1 T (Eq. 5.1), a series of measurements of the T of a tissue as a contrast agent distributes within it could, in principle, be used to monitor the changes in contrast agent concentration. Since the changes in T1 will also alter the signal intensity of a Trweighted imaging sequence, it should also be possible to monitor contrast agent concentration using signal intensity. It is preferable that two further criteria are met. The rate of measurement of contrast agent concentration should be sufficient to monitor the most rapid changes occurring within the tissue. Secondly, the relationship between concentration of contrast agent and the measuring function should be monotonic and minimally affected by small changes in the imaging parameters. In this way the concentration...

Pressures And Resistances In The Cardiovascular System

Although both length and radius of the vessel contribute to its resistance, it is the radius that is altered to modulate flow. Smooth muscle cells in the vessels, especially the arterioles, are arranged such that their contraction or relaxation results in reductions and increases in vessel radius, resp., causing major changes in the resistance to blood flow. Figure 16 illustrates the change in resistance in a single vascular bed that occurs during stimulation of its sympathetic nerves. The perfusion pressure is held constant. Note that at increasing stimulation rates the flow falls, indicating an increase in resistance. Now let's extrapolate this experiment to the intact body under two conditions. First, if there were generalized sympathetic stimulation to all the organs, and if cardiac output (CO) remained constant, then mean arterial blood pressure would increase. That is because the total peripheral resistance

Cbt For Anticipatory Nausea

Clinically, negative side effects of both emetogenic chemotherapy and radiotherapy, common forms of medical treatment for cancer, include anticipatory nausea and vomiting. From a respondent conditioning conceptualization, this occurs when previously neutral stimuli (e.g., colors and sounds associated with the treatment room) acquire nausea-eliciting properties due to repeated association with chemotherapy treatments and its negative aftereffects. Investigations conducted in the early 1980s (e.g., Burish & Lyles, 1981) found progressive muscle relaxation, combined with guided imagery, to be effective in reducing anticipatory nausea and vomiting among samples of patients already experiencing such symptoms. Systematic desensitization has also been found to be an effective intervention for these problems. Moreover, conducting CBT prior to receiving chemotherapy has been found to prevent anticipatory nausea and vomiting, as well as fostering improved posttreatment emotional well-being.

Dynamic Contrast Enhanced Imaging

It has been shown that accurate characterisation of the AIF requires a temporal resolution in the order of a second (Henderson et al. 1998). Furthermore, following bolus injection of a typical clinical dose of contrast agent the T1 of the blood may decrease by more than an order of magnitude (Fritz-Hansen et al. 1996). Monitoring such large changes in relaxation rate requires an imaging sequence with a good dynamic range (Fig. 5.2). Competing directly with this requirement is the need to monitor much smaller changes in T1 at the level of the tissue. The location of the AIF, in relation to the tissue of interest, and the extent of that tissue dictates the requirements for spatial coverage. Finally, it is rare to identify a local feeding artery to provide an AIF but the closer the AIF is to the true tissue arterial supply the more accurate the subsequent modelling (Calamante et al. 2000). However, the spatial resolution of the images places a minimum diameter on the artery to be imaged....

Anesthetic and Analgesic Medications

Due to the ambulatory nature of this surgical procedure, the choice of anesthetic medications is directed toward those with short-duration profiles of action. Midazolam is frequently used as a premedicant. Propent, an agent consisting of equal volumes of propofol and pentathol, has proven to be a valuable anesthetic induction agent for short-duration cases. The mixture provides excellent cardiovascular stability during induction, and we have noted no delays in recovery or discharge compared to the use of propofol alone. The balanced anesthetic technique incorporates volatile anesthetics in oxygen or air with or without the combination of nitrous oxide. A short-acting narcotic such as fentanyl is used, and muscle relaxation accomplished with vecuronium or rocuronium. Succinylcholine is regularly administered for intubation of the trachea. The initial distraction process requires the deepest level of neuromuscular blockade and causes intense surgical stimulation. After fluid distention...

Overview Of Intervention Applications

General behavioral target areas common to most caregiving populations include increasing coping skills, problem-solving skills, time management, prosocial and health behaviors, relaxation, assertiveness, and communication skills. Cognitive targets may focus on decreasing mal-adaptive thoughts and beliefs in connection with feelings of depression, anxiety, or guilt, and increasing positive coping and self-efficacy or self-affirming statements. Services may be structured as therapy, support, psychoeducation, respite, self-enhancement, or a combination of these approaches. Interventions may focus on interpersonal (social isolation, competing work, family, and recreational demands) or intrapersonal (finances, emotional and physical well-being, changes in identity or future goals and expectations) variables, preexisting stressors or problems further complicated by the caregiving role, symptom management, and grief and loss issues. Contrary to many theorists' and researchers'

Systemic Hemodynamic Responses And Conclusions

Many patients receiving diuretic therapy are hypertensive and a long-term goal of the therapy is to achieve sustained reductions in arterial pressure to normo-tensive levels. Indeed, monotherapy with diuretics has long been shown to be an effective treatment for many hypertensive patients. In more resistant cases, combinations of either ACE inhibitors or calcium antagonists with a diuretic have been effective in treating resistant patients. While the antihypertensive mechanisms for agents that directly elicit vascular smooth muscle relaxation are readily apparent, it is more difficult to explain the prompt antihypertensive effects of diuretics that primarily inhibit epithelial transport and do not have much direct effect on vascular smooth muscle to decrease peripheral vascular resistance. Studies in anephric subjects have shown that the direct systemic vasodilatory responses of most diuretics are rather modest. In addition, the immediate effects on arterial pressure of diuretics are...

Cognitivebehavioral Interventions

Cognitive-behavioral interventions have been used with caregivers to improve time management, coping, problem-solving skills, assertiveness, relaxation, positive experiences, and self-care, and to decrease distorted thought processes regarding the caregiving experience. Regardless of the specific technique or modality utilized, the fundamental goal of these interventions is to decrease distress and to improve the caregiver's ability to cope with the multifac-eted caregiving challenges and role changes, improve their sense of control, and overall quality of life. Many of these interventions can be offered in individual, group, or family modalities, and with or without the care recipient present, depending on the nature of individual concerns.

Summary And Conclusion

Extremely challenging and can contribute to considerable psychological distress on the part of the caregiver. Given that there are over 52 million lay caregivers in the United States (Health and Human Services, 1998), and that depression, anxiety, powerlessness, role strain, guilt, and grief are common feelings experienced by caregivers, the need for intervention is clear. While supportive and educational group interventions have long been utilized with this population, caregivers are likely to have needs that are not sufficiently addressed by these types of interventions alone. Thus, the need for more active, directive, goal-driven interventions has been recognized. As discussed in this article, cognitive-behavioral interventions have been increasingly used with the caregiver population to improve coping and problem-solving skills, promote relaxation, enhance self-efficacy and quality of life, and decrease distorted thought processes regarding the caregiving experience. While the...

Matthijs Vos Bob W Kooi Don L DeAngelis and Wolf M Mooij

Web links and heterogeneous food web nodes. We focus on an important class of inducible defenses, those that are reversible (i.e., allow both induction and relaxation of defenses). Reversible defenses include refuge use and other anti-predator behaviors, colony formation and the production of toxins, synomones, and extrafloral nectar. Well-known irreversible induced defenses against visually hunting fish include a reduced age and size at maturity in Daphnia zooplankters (Vos et al., 2002, and references therein).

Fractal Aspects of Protein Structure

The scaling laws determined in this chapter will be of great utility when considering structural issues in later chapters. In Chapter 3, the configurational statistics of loop formation is considered. A number of different loop topologies exist and these will have characteristic scaling laws. These scaling laws are dependent on the mass fractal dimension of the polymer. Considering the complexity of protein structure, it is not surprising that protein dynamics are also quite complicated. Such issues will be taken up in Chapter 5 and 7. In Chapter 5, the surface fractal dimension of protein is used to develop a chemical kinetic model of hydrogen isotope exchange. The model relates structure and kinetics via a fractal dimension, known as a spectral dimension. Chapter 7 considers a similar connection for vibrational relaxation in proteins.

Perioperative Management

Position Arm Dependent Position

A basic requirement of anesthesia for hip arthroscopy is satisfactory muscle relaxation at the hip. This allows distraction of the joint and permits adequate arthroscopic visualization. Regional techniques such as spinal or epidural anesthesia will provide the required muscle relaxation, but often require intravenous adjuncts for patient comfort. Although hip arthroscopy may be accomplished with patients in the supine position on a fracture table,2 the preferred method at our institution is to place the patient in the lateral decubitus posi-tion.3 (See Chapter 9.) After surgical prep and draping, the patient is seldom able to watch the procedure on a video monitor due to obstructed vision. Thus, the advantages of regional anesthetics are lost on two counts The patient's position may be quite uncomfortable during extended cases, and can require substantial amounts of supplemental intravenous medications. Furthermore, patient expectations to remain awake General anesthesia utilizing an...

Function of the large bowel

Defecation is a voluntary act involving the brain, brain stem and spinal cord. The usually empty rectum fills nerve endings are stretched by the contents of the sigmoid colon, causing involuntary contractions of the muscle of the rectum and relaxation of the internal anal sphincter the voluntary external sphincter completes the process. In babies the act is an autonomic response until they are 12-18 months of age when the external anal sphincter comes under voluntary control.

Material Characteristics And Compression

Coprocessing offers an interesting tool for altering these physicomechanical properties of excipients. Coprocessing is generally conducted with a plastic and a brittle excipient. Cellactose is an appropriate example in this regard, which involves coprocessing of 75 lactose (a brittle material) with 25 cellulose (a plastic material) (37). Usage of this particular combination prevents the storage of excessive elastic energy during compression, resulting in a small amount of stress relaxation and a reduced tendency for capping and lamination (38). However, examples of the other extreme also exist, e.g., SMCC, which has a large amount of MCC (a plastic material) and a small amount of CSD (a brittle material). These two cases exemplify the

Selected Motor Lesions Causing Dysphagia

Achalasia is a dysmotility disorder of unknown cause and the most common motility disorder producing dysphagia. Impaired swallowing-induced relaxation of the LES is noted, along with the absence of esophageal peristalsis. Most patients present between 20 and 40 years of age. Achalasia may be associated with esophageal spasm and chest pain and with odynophagia. Associated symptoms can include regurgitation and weight loss. Dilatation of the esophagus can be massive enough to impinge on the trachea and cause airway symptoms.11 Therapy involves decreasing the LES pressure by oral medications, the endoscopic injection of botulinum toxin into the muscle of the sphincter, dilatations, or surgical myotomy.

Control of Pupil Size

Our pupils become larger when we move to a darker environment, and they constrict again when we move back into the light. This light reflex is mediated via contraction and relaxation of the sphincter pupillae muscle, innervated by parasympathetic final motorneurons located in the ciliary ganglia behind the eyeballs. In turn, the final motoneurons are regulated via inputs from brain stem parasympathetic moto-neurons in the Edinger-Westfal subdivision of the oculomotor (cranial III) nucleus located in the mid-brain, ventral to the aqueduct. The afferent limb of the light reflex involves activity in optic nerve (cranial II) fibers, with a branch to the pretectal nucleus in the superior colliculus of the midbrain and from there to the parasympathetic motorneurons in the Edinger-Westfal nucleus.

Are Expressions Necessary For Emotional Experience

The inhibition procedures used in Duclos's study were designed to mimic those used in the behavior therapy technique of systematic desen-sitization in treating anxiety disorders. In systematic desensitization, clients are taught to relax all their skeletal muscles and then to contemplate the objects of their anxiety while maintaining the relaxation (Wolpe, 1958). The muscular relaxation prevents the feelings of anxiety, as self-perception theory would predict as a result, the association between stimulus and anxiety is weakened and eventually disappears. Relaxation techniques are also successful in the treatment of anger (Hazaleus & Deffenbacher, 1986). The success of systematic desensitization therapy demonstrates, in a very practical way, that feelings depend on expressive behavior occurring first.

Pathophysiology of COPD

COPD is characterized by complex and diverse pathophysiological and clinical manifestations. Persistent inflammation ofthe small and large airways, the lung parenchyma, and its vasculature occur in highly variable combinations between patients. Expiratory flow limitation is the pathophysiological hallmark of COPD.1,2 This arises because of intrinsic airway factors that increase airway resistance (i.e. mucosal inflammation edema, airway remodeling and secretions), and extrinsic airway factors (i.e. reduced airway tethering from emphysema).1'2 Emphysematous destruction, particularly in patients with diffuse pan-acinar emphysema, also reduces elastic lung recoil and thus, the driving pressure for expiratory flow, further compounding flow limitation (Figure 4.1). Expiratory flow limitation with dynamic collapse of the airways compromises the ability of patients to expel air during both forced and quiet expiration.2-4 Therefore, during expiration while breathing at rest, many alveolar...

Behavioral Interventions

Behavioral approaches to pain management refer to skills such as relaxation training, pain monitoring, activity scheduling and monitoring, distraction techniques, assertiveness training, and problem solving. To provide some immediate relief from pain, the client can be taught a series of relaxation techniques early in therapy, including deep breathing, progressive muscle relaxation (tensing and relaxing different muscle groups in the body), guided imagery (e.g., imagining a safe place, a place that is free from pain and stress beach or nature scenes), hypnosis (e.g., imagining relaxation moving into different parts of the body), and or biofeedback.

Homework Assignments

Behavior therapists incorporate homework assignments in treatment in order to bring about change and encourage generalization of behaviors to environmental contexts outside of the therapy session. Examples of homework assignments include practicing a relaxation exercise two times per day, engaging in daily in vivo exposure practices, and completing a writing assignment. Specific instructions are provided regarding how to complete homework assignments. The parameters for assignments may include the duration and frequency of tasks, how to structure the environment, and efforts to anticipate factors that may interfere with successful completion of the assignment. Often, monitoring forms are provided so that clients can record the occurrence of specific behaviors between sessions, as well as provide documentation of completed exercises. For example, clients may be asked to monitor daily mood and anxiety levels using a 10-point scale or to record cognitions that occurred in the context of...

The Heart Is An Example Of A Reciprocating Pump

The chamber's volume changes as the piston moves, causing the pressure within to rise and fall. In the heart, the change in volume is the result of contraction and relaxation of the cardiac muscle that makes up the ventricular walls. One complete rotation of the crankshaft in Fig. 1 will result in one pump cycle. Each cycle, in turn, consists of a filling phase and an ejection phase. The filling phase occurs as the pumping chamber's volume is increasing and drawing fluid through the input port. During the ejection phase, the pumping chamber's volume is decreasing and fluid is ejected through the output port. The volume of fluid ejected during one pump cycle is referred to as the stroke volume. The volume of fluid pumped each minute can be determined by simply multiplying the stroke volume times the number of pump cycles per minute.

Dnabinding Cyanine Dyes

The fluorescence quantum yield of cyanine dyes increases when torsional motion around the methine bridge is restricted, which reduces the probability of nonradiative relaxation from the excited singlet state. 7,8 When the dyes bind DNA, internal rotation is likely to be strongly hindered, which causes the dramatic increase in fluorescence.

T2Weighted Perfusion

SE-based EPI techniques are predominantly based on the susceptibility effects rather than changes in the T2 relaxation rate. This is in fact a consequence of the relatively long sampling period of the EPI acquisition technique. The susceptibility contrast arising from compartmentalization of the contrast agent is therefore used to determine relative tissue and relative arterial concentration levels according to Eq. 3, allowing subsequent calculations of rCBV, rCBF, and MTT in the same manner as described in Chap. 4.2.1 (Fig. 7.1).

Physical Examination

The supine or modified lithotomy (frogleg) position is more comfortable for both the patient and the examiner and allows a more thorough examination of each testis, epididymis, the prostate, seminal vesicles, and rectal ampulla. During the critical evaluation of a scrotal mass, patient relaxation and cooperation in the supine position are paramount. Testicular nodularity or firmness should be considered carcinoma until proven otherwise. The epididymis usually lies on the posterolateral aspect of the testis and, if not inflamed or involved with other pathologic entities, has a soft, fleshy feel similar to that of the earlobe. Many males experience pain and tenderness with palpation of a normal globus major (head), body, and globus minor (tail) of the epididymis. All males experience some discomfort during palpation of a normal prostate. The supine position helps prevent an infrequent vasovagal response to the scrotal or prostate examination. The prostate has a heart-shaped contour with...

Endothelial Mechanisms

Endothelial cells contribute to the regulation of arterial blood pressure by regulating vascular tone through activation or inactivation of various circulating vasoactive substances, and by producing numerous agents that can act locally and or systemically to affect vascular tone. Nitric oxide (NO) is a potent vasodilator that is produced in endothelial cells via the oxidation of L-arginine by the enzyme NO synthase. Inhibitors of NO synthase elicit a reduction in blood flow to some tissues and a concomitant rise in arterial blood pressure, suggesting that NO produced by endothelial cells exerts a tonic inhibitory influence on arteriolar tone, thereby contributing to basal blood pressure. Nitric oxide also mediates the endothelium-dependent vasodilation that is elicited by a variety of agents, including acetylcholine and bradykinin. Patients with some forms of chronic arterial hypertension exhibit an impaired endothelium-dependent vascular relaxation, further supporting the...

Other Blood Volumerelated Mechanisms Involved In Blood Pressure Regulation

The stress-relaxation mechanism represents an effort by the blood vessels to fit around the existing blood volume. This phenomenon is related to the intrinsic ability of smooth muscle to return to its original force of contraction after it has been elongated or shortened. Stress-relaxation is more pronounced in the visceral smooth muscle surrounding hollow organs like the urinary bladder, but it does occur to some extent in vascular smooth muscle. Hence, if blood volume and arterial pressure become too high, the blood vessels are stretched and then slowly relaxed as though to accommodate a larger intravascular volume. As a result, the pressure within the arterial tree will fall toward normal. With hemorrhage, on the other hand, a reverse stressrelaxation will cause blood vessels to contract around the reduced blood volume, thereby tending to buffer the fall in arterial pressure.

Functional Anatomy Of The Microcirculation

Blood enters the microcirculation through arterioles, which are surrounded by a thick, continuous layer of smooth muscle. Contraction of smooth muscle reduces the internal diameter of this microvessel and consequently increases the resistance to blood flow in the entire vascular bed. This feature makes the arteriole the major resistance element in the circulation and the principal determinant of the total peripheral resistance. Arteriolar smooth muscle tone also governs the amount of pressure transmitted from arteries to veins hence, capillary pressure falls when arterioles constrict and rises when arterioles dilate. Blood flows from arterioles into a narrower vessel, the metarteriole, which is surrounded by a discontinuous smooth muscle layer. Capillaries branch off from the metarteriole. The density of capillaries, which is an important determinant of the total area available for exchange between blood and tissue, varies significantly between organs,...

Pharmacological Intervention A Oral Medications

In the 1990s, Albright reported that oral medications, including benzodiazepines and skeletal muscle relaxants, had been used with limited success to diminish the effects of spasticity. Diazepam, a benzodiazepine, facilitates the inhibitory response of g-aminobutyric acid (GABA) neurotransmitters by increasing the conductance of chloride ions upon binding to GABAa receptors. This results in a presynaptic inhibition at the spinal cord level with resultant relaxation of skeletal muscle. Use of this agent has been associated with adverse effects including sedation and a potential for dependency.

Techniques Combining T2 T2 or T1

Effect in the measurement of quantitative hemody-namic parameters, such as rCBV, rCBF, and MTT, combined techniques may be useful, involving simultaneous measurements of the changes in the T1, T2, or T2* relaxation rate. To be insensitive to T1 enhancement, a radiofre-quency-spoiled gradient echo sequence is preferred with dual echo acquisition. The change in the T2* relaxation rate, AR2*(t), can then be readily calculated from (Vonken et al. 2000),

Diagnostic Considerations

Comprehensive evaluation of a patient in crisis includes considering diagnoses commensurate with acute stress reactions and posttraumatic stress diagnoses. The DMS-IV-TR (APA, 2000) identifies several diagnoses that include as a criterion exposure to a stressor. These include adjustment disorders, acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and brief reactive psychosis. Meeting the criteria for any of these disorders requires the clinician to consider ongoing treatment. Adjustment disorders present the least impairment along the continuum and include varying types of reactions (with depression, anxiety, mixed disturbance, and so on). ASD requires the patient to have experienced, witnessed, or confronted an intense stressor that involved actual or threatened death or serious injury, or even a threat of the physical integrity of the self or others. Additionally, three main clusters of symptoms must be present. These include the reexperiencing of the event (e.g.,...

Urine Alarm Plus Medications

A second newer medicine is called oxybutynin (Ditropan). Oxybutynin is an anticholinergic preparation that has direct effect on smooth muscle relaxation. This effect reduces the bladder's ability to contract. If the bladder does not contract as much the child would then be allowed to sleep through the night uninterrupted by bladder activity.

Child And Adolescent Therapy

There is emerging evidence supporting the efficacy of acute-phase CBT in treating adolescent depression. Curry (2001) reviewed nine adolescent studies and found CBT to be effective in reducing depressive symptoms and promoting remission in seven studies. CBT was found to be more effective than wait listing controls in four studies, more effective than supportive therapy in two studies, and more effective than family and relaxation therapy (studies are cited in Curry, 2001). Furthermore, CBT led to a more rapid reduction in depressive symptoms than alternative treatments (Brent et al., 1997).

Determinants of Functional Residual Capacity

Lung volume is determined by the interaction of elastic and surface tension forces in the lung and by the elastic properties of the chest wall. This interaction is illustrated in a relaxation pressure-volume curve, obtained from a person breathing from a spirometer (Fig. 6). At specified volumes, the mouthpiece is closed, the person relaxes the respiratory muscles, and pressures are measured. Figure 6 shows pressure-volume curves plotted against the appropriate transmural pressure for the lung alone (Pl), the chest wall alone (Pcw), and intact respiratory system (Prs). The lung curve is a function of Ppl, estimated from esophageal pressure as described earlier, and equals the curve that would be measured using positive pressure inflation on an excised

Leisure Recreation and the Arts

Adults, whether men or women, have little leisure time. However, each does have greater and lesser periods of intensity in the work schedule. The most demanding work can provide an opportunity for recreation. When women prepare flour, for example, many women work together for long hours. When gardens are cut the whole village works together and creates a festive occasion with drinking and joking. Fish poisoning, in the low-water season, is an occasion for festive communal work. On a daily basis, men who are not out fishing or setting traps may weave mats or baskets, play with young children, or converse with other villagers. Early evenings are generally times for relaxation. At these times, people gather in the cleared plaza at the center of the village, joking and

Principal Mechanisms Of Colloidal Stabilization And Destabilization

Bridging flocculation occurs when the loops and tails of a polymer adsorbed to one particle become attached to one or more other particles. The process is optimized for polymers which have several points of attachment on the colloidal surface and are large enough to have free segments (loops and tails) outside the zone of electrostatic repulsion and available to bind to other surfaces. The surface coverage of the adsorbed polymer appears to be a fundamental parameter controlling the probability of bridging65 with the half surface coverage postulated as the optimum condition for flocculation to occur.66 While flocculation can occur for polymers that are at equilibrium with the colloidal surface,67 nonequilibrium flocculation, occurring before the polymers are able to completely collapse on the colloidal surface, is thought to predominate.68 In that case, the dynamics of bridging flocculation are related to both the thermodynamics and kinetics of polymer adsorption, including transport...

Case Illustrations

Nature of panic disorder describes a variety of cognitive and behavioral strategies including relaxation, cognitive restructuring, breathing retraining, and exposure and advises readers how to use these strategies. It describes cognitive strategies such as exploring faulty logic, reconsidering attributions, exploring alternatives, decatastrophizing, and hypothesis testing. Participants were informed that reading the book was designed to help them deal better with their panic attacks and that they would be contacted at weeks 2 and 4 by the researcher to assess their progress in reading the book. Calls lasted about 10 min a written protocol was followed, and callers were coached not to answer questions about any particular reader's program. Rather, participants were questioned to see if they were reading the book and to check their progress. The authors reported that, overall, participants in the biblio-therapy group were more improved than were participants in the wait-list group and...

Function of endothelial cells

Owing to the strategic location of the endothelium, it is able to perform many different functions. In addition to acting as a protective barrier, endothelial cells have been shown to play important roles in control of homeostasis, capillary transport, and, more importantly, regulation of the tone of underlying vascular smooth muscle. The endothelium evokes relaxation of these muscle cells, allowing vasodilation via the chemical factor endothelium-derived relaxing factor (EDRF), which has been identified as nitric oxide (NO). The EDRF or NO is vital for maintaining the vasodilatory capacity of vascular muscle and also controls levels of platelet function and monocyte adhesion. Any endothelial injury or dysfunction could therefore be an important factor in atherosclerosis.

Elizabeth A Gosch and Aaron Pollock

Depression in children tend to focus on operant principles. Lewinsohn (1974) associates depression with low levels of positive reinforcement, particularly social reinforcement, due to problems in available reinforcement systems and deficits in social skills. Behavioral interventions designed to increase the child's access to positive reinforcement and decrease depressive symptoms include activity scheduling, pleasant events monitoring, selective reinforcement, and skills training (e.g., social, problem solving, and relaxation skills). Self-control models incorporate behavioral and cognitive components by focusing on overly high expectations, selective attention to negative events, and rates of positive self-reinforcement punishment.

Therapeutic Implications

Myocardial perfusion can only occur during the relaxation phase provided during diastole. The perfusion is markedly impaired under conditions of low cardiac output. Because the coronary perfusion pressure is the difference between the diastolic pressure minus the coronary sinus venous pressure, it follows that any situation that lowers diastolic pressure to 30 to 40 mmHg can lead to poor coronary perfusion, myocardial ischemia, and subsequent ECG changes reflecting injury. Treatment of low diastolic pressure includes infusion with a-adrenergic agents such as phenylephrine, norepinephrine, and epinephrine to raise the diastolic pressure and coronary artery perfusion.

Multisite ventricular pacing

Many patients with advanced IDC have abnormal left ventricular activation that in turn results in prolonged and incoordinate ventricular relaxation. In some patients ventricular conduction delay is also associated with prolongation of atrioventricular conduction, resulting in a loss of atrioventricular synchrony and a predisposition to prolonged functional mitral regurgitation. Dual chamber pacing has been advocated as a method for restoring AV synchrony and improving left ventricular coordination in patients with severe congestive heart failure. Although initially favourable haemodynamic results using conventional right ventricular pacing were not confirmed by later studies, there has been a more consistent response in studies that have used biventricular pacing, the outcome depending critically on the native QRS duration and the paced AV delay.19 Patients should be considered for biventricular pacing if they have QRS duration greater than 150 ms, PR interval prolongation, and...

Shamanistic Therapeutic Processes

Therapeutic mechanisms of shamanistic healing derive from ASC, community relations, and ritual spirit-world interactions. ASC have physiological effects, including the relaxation response, the elicitation of opioid release, and enhanced serotonergic action. The spirit world plays a role as sacred others, representing personal and community identity models and aspects of the psyche. The spirit world and community's therapeutic roles include models for development, social support, and community bonding. Ritual processes manipulate physiology, psychology, and social relationships for therapeutic processes.

Pelvic Floor Disorders

The commercially available probe has three balloons attached to it. The pressure in the balloons is displayed on a monitor or polygraph record so the individual can observe changes in the pressure, as the manipulation of the walls of the rectum is accomplished by inflating the most internal balloon with air, causing a pressure wave that simulates feces moving into the rectum. The two other balloons are positioned on the probe to measure the contraction and relaxation of the internal and external sphincters. When proper sequencing of the internal and external sphincters occurs, the internal sphincter will relax, causing a decrease of pressure in the middle balloon, and the external sphincter will contract, causing an increase in pressure in the external sphincter balloon. When an inappropriate sequence is observed on the display, this is pointed out to the individual and instructions on what the display should look like is explained so the individual can then try to exert deliberate...

Echo Pulmonary Vein Doppler

Pulmonary Venous Doppler Young

AR, pulmonary venous peak atrial contraction reversal velocity EDT, early left ventricular filling deceleration time IVRT, isovolumic relaxation time S D, systolic-to-diastolic pulmonary venous flow ratio. AR, pulmonary venous peak atrial contraction reversal velocity EDT, early left ventricular filling deceleration time IVRT, isovolumic relaxation time S D, systolic-to-diastolic pulmonary venous flow ratio. If elevated intracardiac filling pressures are superimposed upon impaired LV relaxation, the Doppler pattern of mitral inflow can again appear normal, with an E A ratio greater than 1 and decreased E-wave deceleration time (Fig. 7). This occurs because increased LA pressure re-establishes a higher gradient between the LA and the LV, providing a larger pressure head to drive LV filling in early diastole. The result is a higher peak E-wave velocity and more rapid filling (decreased E-wave deceleration time). The fact that this apparently normal pattern occurs in the presence of...

Essential Hypertension

There is substantial research on the treatment of essential hypertension with biofeedback. Studies show that frontal EMG, finger temperature, SCA, and direct blood pressure feedback have all been used successfully. Most of the research supports combining the biofeedback with some relaxation strategy such as progressive muscle relaxation, or autogenic training. Although direct blood pressure feedback might seem superior because it is straightforward, the research does not support it as a treatment of choice, as the other techniques generally reduce blood pressure more than direct blood pressure feedback.

Ethidium bromide titration

We have seen that binding of ethidium bromide changes the conformation of closed-circular DNA, producing a reduction in twist and a corresponding increase in writhe. Since these changes have an energetic cost, the intrinsic binding affinity of ethidium bromide (EtBr) is modulated by the topological state of the DNA. In particular, EtBr will bind with higher affinity to a negatively supercoiled molecule (ALk < 0) than to an unconstrained molecule (e.g. nicked-circular), since binding results in a reduction in the energetically unfavourable (negative) writhing of the supercoiled molecule, as well as the reduction in twist that occurs in both closed-circular and nicked molecules. On the other hand, binding of ethidium bromide to relaxed or positively supercoiled DNA is less favourable than to nicked-circular, since this results in the introduction of (positive) writhing. This is the reason that the numbers used in the example in Section 2.5.6 are not strictly accurate Relaxation of the...