Q. Marik. Northeastern University.

Being happily married is just my strong preference buy norvasc 2.5 mg, and I don’t have complete control over the outcome — it does take two generic 10mg norvasc overnight delivery, after all order norvasc no prescription. Vanquishing victim words Victim words, such as powerless, helpless, vulnerable, overwhelmed, and defenseless, put you in a deep hole and fill you with a sense of vulnerability and fear. They make you feel as though finding a way out is impossible and that hope remains out of reach. Nevertheless, victim words can become what are known as self-fulfilling prophecies. Is there anything at all that you can do to remedy or at least improve your problem? Think about a friend, an acquaintance, or anyone at all who has successfully dealt with a burden like yours. After you consider the logic and the evidence, ask whether victim words make you feel better, calmer, or less anxious. If not, replace those words with new ones, as in the following examples: Chapter 6: Watching Out for Worry Words 99 ✓ Victim: I have a fatal disease, and I’m totally powerless to do anything about it. However, I can explore every avenue from new experimental treatments to alternative treatments. However, I could go to a credit-counseling agency that specializes in renegotiating inter- est rates and payments. While one person may become anxious about traffic, airplanes, or health, another becomes anxious about finances, and still another feels anx- ious only around bugs. This chapter explains why different people respond to the same event in extremely different ways. We show you how certain beliefs or assumptions about yourself and the world cause you to feel the way you do about what happens. One way to think about these schemas or beliefs is to think of them as lenses or glasses that you look through. As you know, sometimes lenses can be cloudy, dirty, smoky, cracked, distorted, rose-colored, or clear. Some schema lenses make people scared or anxious when they see their world through them. These beliefs come primarily from your life experiences — they don’t mean you’re defective. Of course, as discussed in Chapter 3 and elsewhere, all aspects of anxiety are also influenced by biological factors. The question- naire in this chapter helps you discover which assumptions may agitate and create anxiety in you. Replacing your agitating assumptions with calming schemas can reduce your anxiety. Understanding Agitating Assumptions A schema is something that you presume to be correct without question. You don’t think about such assumptions or schemas; rather, you take them for granted as basic truths. For example, you probably believe that fall follows summer and that someone who smiles at you is friendly and someone who scowls at you isn’t. You assume without thinking that a red light means stop and a green light means go. Your assumptions provide a map for getting you through life quickly and efficiently. That assumption allows them to plan ahead, pay bills, and avoid unnecessary worry. If people didn’t make this assumption, they’d constantly check with their payroll department or boss to ensure timely delivery of their checks to the annoyance of all concerned. Unfortunately, the schema of expecting a paycheck is shattered when jobs are scarce or layoffs increase. Understandably, people with expectations of regular paychecks feel pretty anxious when their assumptions don’t hold true. They assume that the food sold in the grocery store is safe to eat — in spite of occasional news reports about tainted food showing up in stores. On the other hand, food sold on a street corner in a third-world country might be assumed to be less safe to eat. So, while people act on their schemas and assumptions, they’re not always correct in doing so. You may worry that you’ll stumble over your words, drop your notes, or even worse, faint from fear. Even though these things have seldom happened when you’ve previously given speeches, you always assume that they will this time. Anxious schemas assume the worst about yourself or the world — and usually they’re incorrect. Therefore, agitating assumptions can go unchallenged for many years, leaving them free to fuel anxiety. Chapter 7: Busting Up Your Agitating Assumptions 103 Sizing Up Anxious Schemas Perhaps you’re curious as to whether you hold any anxious schemas. People usually don’t even know if they have these troubling beliefs, so they don’t ques- tion them. In the following sections, we identify five anxious schemas and then provide a quiz to help you determine whether you suffer from any of them. Recognizing schemas In our work with clients, we’ve found that five major anxious schemas plague them: ✓ Perfectionism: Perfectionists assume that they must do everything right or they will have failed totally, and the consequences will be devastat- ing. These anxious schemas have a powerful influence on the way you respond to circumstances. For example, imagine that the majority of comments you get on a performance review at work are quite positive, but one sentence describes a minor problem. Each schema causes a different reaction: ✓ If you have the perfectionism schema, you severely scold yourself for your failure. Just imagine the reaction of someone who simultaneously holds several of these schemas. One sentence in a performance review could set off a huge emotional storm of anxiety and distress.

If we can find remedies which will reach and correct these purchase norvasc paypal, the disease is at an end purchase norvasc with a visa, and the natural restorative power of the body soon gives health order norvasc 10 mg online. The most simple form of specific medication is where a single remedy is sufficient to arrest the process of disease. As when we prescribe Collinsonia for ministers’ sore throat, Drosera for the cough of measles, Belladonna for congestive headache, Macrotys for muscular pains, Hamamelis for hemorrhoids, Phytolacca for mammary irritation, Cactus for functional heart disease, Staphysagria for prostatorrhœa, etc. This use of remedies gives great satisfaction in the treatment of many diseases, and we are led to wish that the practice of medicine could be resolved into the giving of such specifics. Not quite so simple, but yet very plain is the second form of direct medication, illustrated by the following examples. A heavily loaded tongue at base, with a bad taste in the mouth and fullness in the epigastric region, demanding an emetic. A uniformly yellowish coated tongue from base to tip, relieved by Podophyllin or Leptandrin. A pallid large tongue, with a moist pasty coat, demanding the alkaline sulphites, say sulphite of soda. Quite as plain, but not so easily and directly reached by medicine, is the need of a good condition of the intestinal canal for digestion and blood making, and associated with it the recognition of the need of certain restoratives that may be necessary to normal nutrition and functional activity. In acute cases, it is required first to rid our patient of functional disease before we can fully establish digestion and nutrition, but in chronic disease it will many times stand first, and must always be associated with treatment for local lesions. The complement of this is, treatment to increase the removal of old and worn-out tissues, and thus relieve the solids and fluids of material that must necessarily depress functional activity. Probably we have as little positive knowledge of remedies that increase retrograde metamorphosis, as of any other class, still they are being studied, and in time we will be enabled to use them directly. Remedies that increase excretion are in common use, and form a very important part of our practice. From the earliest periods of medicine, the fact that disease is destructive has been recognized. Destruction of the material of our bodies, necessarily leaves the debris either in solids or fluids, and experience has shown that it can not remain in the body with safety. But there has been a failure to appreciate the true nature of these processes, and from this has flowed a very great deal of bad practice. These processes are strictly vital processes, carried on by delicate organisms under the control of the nervous system. As they are the basis of life, we may well suppose that nature has guarded them on all sides, and that they are the true centre of life. The doctor of the olden time has looked upon them as mechanisms to be powerfully influenced by remedies. He powerfully excites the stomach and intestinal canal as a means of derivation, and works upon the skin and kidneys as if secretion from them were a purely physical process. Any one who will take up Huxley’s Physiology, and read the clear and simple description of this apparatus for digestion and waste, upon which our lives rest, can not but be satisfied that the common practice of medicine is a very great wrong. Take away this power and he will die in a brief time; take it away in part, and you have lessened his power to that extent; take it away for an hour, for a day, or for a week, and his power to live is weakened to that extent. Studying the condition of the stomach and intestinal canal in this light, we will see how a direct stimulant, or tonic, an alkali, an acid, a remedy that will relieve nervous irritation, or one that will give increased innervation, will in different cases be an aid to digestion. Looking farther, we will see the necessity, in one case of histogenetic food, in another of calorifacient, in one of iron, in another of phosphorus, etc. It is just as much specific medication to be able to select the proper food for the sick as it is the proper medicine. The past winter I was called in consultation, in a case of continued fever in the third week. The treatment, so far as medicine was concerned, had been very judicious, but the food had been starchy, and for a week the patient had been able to take very little. The most striking features of the disease to me were: the feebleness of the heart’s action, the want of respiratory power, and the evidences of a general failure of muscular power - in all other respects the patient was in good condition. I advised enemata of beef-essence, and its internal administration in small quantities frequently repeated, and a suspension of all medicine. She was very feeble, and I had been giving her freely of the bitter tonics, stimulants and animal food. The old Quaker remarked, if thee will stop the medicine and stimulants, and give her fatty matter she will recover - and the result justified the old doctor’s skill in diagnosis. I have had to take this advice twice in the past eighteen months, from other parties, when I should have recognized it myself; in both it was the one thing necessary to success. With regard to excretion, we must be thoroughly impressed with the fact that it is wholly a vital process, and not a process of straining. When we come to understand that a secreting organ is continually growing secreting cells, and that these withdraw from the blood the worn-out materials of our bodies, we will be in a position to use remedies with better success. Evidently it is possible to so over-stimulate or over-work an excretory organ, that this function of cell- production will be very much diminished or altogether arrested. The best remedies to increase secretion are those that act mildly and stimulate vital function. All can succeed with it, yet successes will be in proportion to the physician’s acuteness of observation, and to some extent upon his knowledge of remedies. We study not so much the grosser manifestations of disease, but the more delicate shadings and combinations, and our therapeutics requires that we have a most intimate knowledge of the influence of remedies upon the human body. In this field of study the physician will find a beauty and certainty, in the practice of medicine that will give zest to investigation, and as it is pursued he will find greater and greater success. The question has been asked, “In what does your theory of specific medication differ from Homœopathy? The law, similia similibus, upon which the Homœopathic practice is based, is defined in two ways. One contends that the drug, used for cure, “produces the essential morbid condition” when proven in health. The other, “that it produces similar symptoms,” but not the exact pathological condition.

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Focus on the idea that ‘your thoughts are not you purchase cheapest norvasc, they are just passing through’ buy cheapest norvasc. Pick something that will serve as a cue for you that occurs during your average day and use it as a reminder to simply observe your thoughts for a moment before you act on them discount norvasc 10 mg free shipping, just as you’ve been doing throughout this chapter. Your cue could be as simple as sitting down to eat a meal, getting ready to go for a walk, picking up your phone to make a call, going into the bathroom, sitting in your car for a moment before driving, whatever works for you. Stick a Post-it note up somewhere to remind you that it’s your intention to focus on your thoughts in that situation. In this Ichapter, I’m going to have you take a look at how these thoughts can link together habitually in what becomes your own personal belief system. A belief system is really just a pattern of stories that you have been taught or have learned since childhood, or that you have developed in response to your own experiences. It’s how you frame and understand the things that you encounter in the world around you. You have created a personal belief system about everything you have ever come across, every new discovery, every interaction and every activity, in order to fit things in with what you already know. You never just experience something without also experiencing the story that you then create about the event, based on your personal belief system. This is part of how one thought leads to another in patterns that tend to repeat themselves. It’s a normal part of your brain’s functioning to try to make sense of the world by relating new things to what you’re already familiar with. However, what’s helpful to you in providing meaning and context for novel experiences can also be harmful to you if you have developed a belief system that encourages a stress response. For example, when you look at another person, you project your belief system onto him or her. This helps you to decide if someone is to be approached as a friend or feared as a threat. But your first impressions, your beliefs, your patterns and 23 24 • Mindfulness Medication your stories are not necessarily true. He’s a big man and a little scary looking, but you couldn’t ask for a nicer person. We all form immediate opinions about the people we meet based on prior experiences, our cultures, our previously formed opinions and our upbringings. We form judgments about people without even having talked to them and without knowing who they really are and those judgments could be incorrect. If your belief system encourages you to judge a person negatively, then of course your behaviour toward that person will reflect that judgment. You could be in immediate and stressful conflict with someone based on a habitual response pattern triggered by his or her clothing, smile, or hair color. Many times, if people are acting, or dressing, in ways that don’t fit with how you believe they should be behaving, or looking, then you most likely react negatively to them. However, what you’re actually doing is reacting to a behaviour that you see in those people that you reject or deny in yourself. For example, if you see someone who is dressed in what you feel is a sloppy manner; you may find yourself thinking negative thoughts about him or her. You’re really rejecting the idea of ‘being sloppy’ yourself and so, you reject the characteristic when you see it in another person as well. Your parents may have initially defined “sloppy” for you as a negative characteristic. When you see someone who is dressed in what you describe as a sloppy fashion, you’re really just reinforcing the idea that you reject that quality in yourself. An understanding of belief systems and patterns can allow you to see that judgments are more about your own history than about the person, event, or situation being judged. But these judgments are really just stories that extend beyond the actual reality of the event itself, or the new person that you’re meeting for the first time. These stories are simply your belief system at work trying to help you negotiate and understand your daily environment. Despite the fact that your belief system seems The Origin of Thoughts • 25 true for you at any given time, it’s really just a set of interpretations, or tales, that you tell yourself. You have internal and external sensations that are constantly demanding your attention, but what’s instantly created in response to these circumstances is a story… your story. Even your thoughts, as they pop up out of nowhere, are immediately captured and slotted into existing patterns. It remembers the conditioned, reactive story that you created around the initial event, sensation, or perception and that becomes your reality. You completely forget the original event and only see the situation from the perspective of your own story. Isn’t it fascinating that we all lead our lives through the ways in which we look at the world? We can only perceive it through the unique filters of our belief systems and the stories that those systems tell us. Let’s take a look now at how your mind reacts to the internal and external sensations that you’re receiving. I’m going to suggest various images for you to think about and I’d like you to just notice what stories occur for you in response to the original thought. Choose to think about someone that is very neutral to you, such as the newspaper delivery person, or the person at the checkout at the grocery store. When you look at someone you don’t like, your thoughts and stories about that individual will reveal characteristics like negativity, selfishness and aggression. Even just walking down the street, your belief system has something to say about almost everything and everyone. You might see someone with tattoos and/or body piercings and think about that person in a certain way. Someone else could view the same individual in exactly the opposite fashion, because his or her belief system has something else to say. So now you have an idea that what goes on around you is filtered through the stories that you create in response to your belief system. You may have had the experience of having been in a relationship where originally you were in love and your partner could do no wrong. Unfortunately, over time, this perspective may have changed and in the end, now that the relationship is over, you view your former partner in a totally different and negative way. A friend may have acted in a way that you felt was rude, or mean and then you discover that they have suffered a significant loss recently and are grieving.

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She considers cessation of her cocaine habit secondary to cessation of her heroin abuse buy norvasc overnight. She initially stated that she wanted to change her life generic norvasc 10 mg with visa, including having her own permanent housing order norvasc with amex, and she wanted to stop prostituting. Although stabilized on methadone, she continued to use cocaine on a regular basis during her first 6 months in treatment. She was assessed as having severe depression, with suicidal ideation, and escalation of cocaine abuse. Although attempts have been made to motivate patient to stop cocaine use, these attempts have been unsuccessful. Address imminent danger of suicide by developing a service plan in conjunction with mental health provider. PatientñTreatm ent M atching 99 The M ultidisciplinary Team staff on all aspects of patient care, particularly drug interactions Approach ï Nonmedical professional staff members (e. The consensus panel psychotherapy and family therapy, psycholog- recommends that the treatment team consist of ical testing and evaluation, health education, the following: and vocational skills assessment and training ï A physician trained in addiction psychiatry, ï A certified or licensed addiction specialist or who provides leadership, health care, and drug counselor medical stabilization; conducts detailed ï Nontreatment and administrative staff mem- evaluations of the patient; monitors medica- bers (e. Chapter… The sequential treatment phases described in this chapter apply primari- ly to comprehensive maintenance treatment, rather than other treatment Rationale for a options such as detoxification or medically supervised withdrawal. This chapter builds ment of, or referral for, other health care and on, adapts, and psychosocial needs. In general, most patients extends their model need more intensive treatment services at entry, as part of an overall more diversified services during stabilization, strategy for matching and fewer, less intensive services after bench- [T]reatment patients with treat- marks of recovery begin to be met (McLellan et ments. Some progress through only some the levels of care phases, and some return to previous phases. As described in chapter 4, assessment of patient readiness for a particular The model is not one directional; at any point, phase and assessment of individual needs patients can encounter setbacks that require a should be ongoing. Therefore, the chapter includes strategies for addressing setbacks and recommendations for handling Duration of Treatm ent W ithin transitions between phases, discharge, and and Across Phases readmission. The implications of both tracks should be based on accumulated data and are discussed. Although most patients would medical experience, as well as patient partici- prefer to be medication free, this goal is diffi- pation in treatment, rather than on regulatory cult for many people who are opioid addicted. These patients usually do highly intensive services during the acute not wish to be admitted for or do not meet phase, especially for patients with serious Federal or State criteria for maintenance treat- co-occurring disorders or social or medical ment. During this process, patientsí basic hours, as well as inappropriate use of other living needs and their other substance use, co- psychoactive substances. This process involves occurring, and medical disorders are identified ï Initially prescribing a medication dosage that and addressed. Patients also may be educated minimizes sedation and other undesirable about the high-risk health concerns and prob- side effects lems associated with continued substance use. If these lessen the intensity of co-occurring disorders patients meet Federal and State admission cri- and medical, social, legal, family, and other teria, their medically supervised withdrawal problems associated with opioid addiction from treatment medication should end, their medication should be restabilized at a dosage ï Helping patients identify high-risk situations that eliminates withdrawal and craving, and for drug and alcohol use and develop alterna- their treatment plans should be revised for tive strategies for coping with cravings or long-term treatment. Chapter 5 details the procedures for determin- Patients adm itted for ing medication dosage. Some patients may require receive information about how other drugs, focused, short-term pharmacotherapy, psycho- nicotine, and alcohol interact with treatment therapy, or both. However, many patients medications and why medication must be may have co-occurring disorders requiring a reduced or withheld when intoxication is evi- thorough psychiatric evaluation and long-term dent. W hen substance abuse continues during treatment to improve their quality of life. M edical and dental problem s In addition, the consensus panel believes that Patients often present with longstanding, frequent contact with knowledgeable and car- neglected medical problems. These problems ing staff members who can motivate patients to might require hospitalization or extensive become engaged in program activities, especial- treatment and could incur substantial costs for ly in the acute phase, facilitates the elimination people often lacking financial resources. Patients should be monitored closely ty as soon as possible, preferably in the acute for symptoms that interfere with treatment phase. On behalf of those on probation or because immediate intervention might prevent parole or referred by drug courts, program patient dropout. Before they transition addition, when treatment to the rehabilitative phase, patients should providers remain flex- begin to develop the coping skills needed to ible and available outcomes... A patientís inability to gain this phase, they contribute control may necessitate revision of the treat- to patientsí sense of ment plan to assist the patient in moving past security. The process often includes to reach staff in an emergency can foster meeting directly with the patient to assess moti- patientsí trust in treatment providers. M otivation and patient readiness Therapeutic relationships As discussed in chapter 4, patient motivation Positive reinforcement of a patientís treatment to engage in treatment is a predictor of reten- engagement and compliance, especially in the tion and should be reassessed continually. It importance of the therapeutic bond between might help to acknowledge the weaknesses of patients and treatment providers and reviews past staff efforts and to focus on future actions practical techniques to address common to move treatment forward. Research has shown that them, and indicators for subsequent transition patient motivation, staff engagement, and the to the supportive-care phase. Faith-based organizations abuse, medical problems, co-occurring disor- can provide spiritual assistance, a sense of ders, vocational and educational needs, family belonging, and emotional support, as well as problems, and legal issuesóso that they can opportunities for patients to contribute to their pursue longer term goals such as education, communities, and in the process can educate employment, and family reconciliation. Stabilization of dosage for opioid treatment Relapse triggers or cues such as boredom, medication should be complete, although certain locations, specific individuals, family adjustments might be needed later, and patients problems, pain, or symptoms of co-occurring should be comfortable at the established dosage disorders might recur during the rehabilitative for at least 24 hours before the rehabilitative phase and trigger the use of illicit drugs or phase can proceed. Patients should be emphasized in this phase (Sandberg also should receive information on the risks of and Marlatt 1991) and might involve individu- smoking, both for their own recovery and for al, group, or family counseling or participation the health of those around them. The consensus panel recommends that, abuse and use of illicit drugs once a patient is progressing well and has con- ï Ongoing health concerns sistently negative drug tests, the frequency of ï Acute and chronic pain management random testing be decreased to once or twice per month. The criteria for this should be part ï Employment, formal education, and other of the treatment plan. If a patient is ments with other service providers should be using medications, particularly drugs of poten- in place. A patientís health needs and should sign an informed consent statement should be diagnosed and treated immediately. Eventually, patients should demon- should continue, and the patient should remain strate adherence to medical regimens for their in the rehabilitative phase. Patients who con- chronic conditions and address any acute tinue to use illicit drugs or demonstrate alcohol conditions before they are considered for tran- use problems are not eligible for take-home sition from the rehabilitative phase to subse- medication. Patients with disabilities usually involves opioid medications, programs should be educated about the basics of the should work with patients to recognize the risk Americans with Disabilities Act and any local of relapse and provide supports to prevent it antidiscrimination legislation and enforcement. By the end of the rehabilitative phase, patients should be employed, actively seeking employ- Em ploym ent, form al ment, or involved in a productive activity such education, and other as school, child rearing, or regular volunteer incom e-related issues work. Efforts can be made to encourage business, industry, and Transition from the rehabilitative phase should government leaders to create income-generating require that patients have a social support sys- enterprises that provide patients with job skills tem in place that is free of major conflicts and and opportunities for entry into the job market that they assume increased responsibility for and to preclude employment discrimination their dependents (e.

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