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Kendall L. Stewart, M.D. May 9, 2008

The Stressed Patient An Overview of the Progressive Muscular Relaxation Process A Presentation for SOMC Medical Education. Kendall L. Stewart, M.D. May 9, 2008. 1 I hope to offer practical insights that will assist you in serving your stressed patients and in reducing the stress in your life.

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Kendall L. Stewart, M.D. May 9, 2008

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  1. The Stressed PatientAn Overview of the Progressive Muscular Relaxation ProcessA Presentation for SOMC Medical Education Kendall L. Stewart, M.D. May 9, 2008 1I hope to offer practical insights that will assist you in serving your stressed patients and in reducing the stress in your life. 2Please let me know whether I succeeded on your evaluation forms.

  2. Why is this important? • Many of your patients will complain about stress.1,2 • Many who are stressed will complain about something else. • Most stressed patients are looking for a pill. • They will usually be convinced that someone else is to blame. • A few will take personal responsibility for their stress and seek your advice about how to manage it better. • This presentation is for them. • After this presentation, you will be able to • Describe the extent of the problem with stress in our culture, • Identify the most common “causes” of stress • Conduct a practical exercise that will temporarily decrease the stress in life. • For those rare patients who will practice this exercise regularly, this will become an valuable tool in their lifelong efforts to minimize the negative impact of stress on their lives. 1Many of these stressed patients will demand that you declare them disabled—particularly as they near retirement. 2A patient with successfully-treated depression insisted on my declaring her disabled when she became miserable in her job.

  3. What is the impact of stress on our patients? • Forty-three percent of all adults suffer adverse health effects from stress. • Seventy-five to 90% of all doctor's office visits are for stress-related ailments and complaints. • Stress can play a part in problems such as headaches, high blood pressure, heart problems, diabetes, skin conditions, asthma, or arthritis in addition to depression and anxiety. • The Occupational Safety and Health Administration (OSHA) declared stress a hazard of the workplace. • Stress costs American industry more than $300 billion annually. • The lifetime prevalence of an emotional disorder is more than 50%, often due to chronic, untreated stress reactions.1 1Information provided by Jerome F. Kiffer, MA, Department of Health Psychology and Applied Psychophysiology, The Cleveland Clinic Foundation on WebMD.com

  4. Why do patients complain that they are stressed? • “It’s my job.” • “It’s my boss.” • “It’s my spouse.” • “It’s my kids.” • “It’s my family.” • “It’s money.” • “It’s this pain.” • “It’s the government.” • “It’s the insurance companies.” • “It’s the idiots on the road.” • “It’s not my fault.” • (But it always is.)1,2,3 1It is pointless to argue with patients who are consumed with any strongly-held belief. 2A man presented with the conviction that someone had drugged him through his well water and stolen country songs. 3A man believed that God had turned a deer around so he could shoot it.

  5. What are the key steps in the progressive relaxation process?1,2 • Explain the process. • Obtain informed consent. • Make it clear that the patient may end the process at any time. • Assume a relaxed position. • Close your eyes. • Focus intently on tensing the relaxing specific muscle groups. • Debrief afterwards. • Consider making recording. • Recommend weekly practice. 1 The relaxation response includes changes in metabolism, heart rate, respiration, blood pressure and brain chemistry. 2Let me illustrate the process.

  6. Where can you learn more?1 • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2000 • Department of Behavioural Neurosciences, McMaster University, PsychDirect: Evidence Based Mental Health Education & Information, http://www.psychdirect.com/anxiety/soc.html • Goldman HH, Review of General Psychiatry, Fifth Edition, 2000 • Kaplan HI, Sadock BJ, Synopsis of Psychiatry, Tenth Edition, 2007 • Jacobson JL and Jacobson AM, Psychiatric Secrets, Second Edition, 2001 • Benson, H and Klipper, M, The Relaxation Response, Harper, 2000 • Stewart KL, “Dealing With Anxiety: A Practical Approach to Nervous Patients and an Overview of the Objectives in the Anxiety Module in the OUCOM Psychiatry Block,” 2000 1Please visit www.KendallLStewartMD.comto download related White Papers and presentations.

  7. How can you contact me?1 Kendall L. Stewart, M.D. VPMA and Chief Medical Officer Southern Ohio Medical Center President & CEO The SOMC Medical Care Foundation, Inc. 1805 27th Street Waller Building Suite B01 Portsmouth, Ohio 45662 740.356.8153 StewartK@somc.org KendallLStewartMD@yahoo.com www.somc.org www.KendallLStewartMD.com 1All speaking and consultation fees benefit the SOMC Endowment Fund.

  8. Are there other questions? www.somc.org SafetyQualityServiceRelationshipsPerformance 

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