Handout: Self-esteem Barometer

13 Wednesday Apr 2022

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handouts, Self Esteem

Posted by RichardB | Filed under Creative Therapy Tools, handouts

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Handout: How I see myself

10 Thursday Feb 2022

Posted by RichardB in Creative Therapy Tools, Handout

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handouts, Psycho-educational

I have spent many years working with groups in a therapeutic setting and the last 17 years have been mostly psycho-educational. The manner that I facilitate groups in this process starts with a lot of direction, as the clients/patients open to sharing so do the boundaries (meaning less direction). Below is an image of a handout I have used.

One day a client mentioned that how others see him is totally different than how he sees himself. So, I added another part (asking folks to write on the back of the page): “how do you think others see you positively/negatively.

At the end of groups, I often ask what was it like doing this activity (useful, annoying, stupid, ect). Folks nearly always reported for this handout that it was useful. The addition of how others see us opened a whole new conversation level about the perceptions of others.

Evidence based Yoga

02 Wednesday Jun 2021

Posted by RichardB in Health, Wellness, Yoga

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activities, ADHD, adherents, alignment, analysis, Another, asanas, assessments, asthma, attention, attitude, author, authors, Back, behavior, benefits, Both, bronchodilator, Cardiovascular, cases, Cochrane, composition, concentration, conclusions, consensus, deficit, difference, disease, disorder, disorders, efficacy, energy, Europe, Evidence, Except, factors, handouts, harmony, Hatha, health, improvement, inadequacies, India, Indian, indices, instructor, intervention, interventions, Iyengar, life, lifestyle, literature, measures, medication, medicine, Meditation, metabolic, method, methodology, origins, outcome, output, Overall, pain, Patients, persons, philosophy, postures, pranayama, purposes, questionnaire, Raja, RCTs, relaxation, resistance, response, restriction, results, selection, self, sessions, Spirometry, status, stimulus, subjects, symptoms, syndrome, techniques, therapy, times, tolerance, tradition, treatment, trend, viniyoga, week, weeks

Yoga is a mind and body practice in complementary medicine with origins in ancient Indian philosophy. The various styles of yoga that people use for health purposes typically combine physical postures, breathing techniques, and meditation or relaxation. There are numerous schools of yoga. Hatha yoga, the most commonly practiced in the United States and Europe, emphasizes postures (asanas) and breathing exercises (pranayama).

Since the 1020’s researchers have been studying and publishing articles on the results of a Yoga practice. Listed below are some of the research results of Hatha Yoga and specific medical conditions. :

ADHD Eighteen boys with diagnosed attention-deficit/hyperactivity disorder (ADHD) were randomly assigned to either a yoga treatment or a cooperative activities group. After 20 sessions of yoga, the boys showed improvement on a variety of indices, including oppositional behavior, emotional lability, and restlessness or impulsivity. The subjects exhibited a dose/ response curve, with those subjects who participated in additional home practice showing a greater response. The control group showed superior scores on measures of hyperactivity, anxiety, and shyness, as well as social function measures.⁷

Anxiety A meta-analysis of the research involving yoga interventions for anxiety and related disorders reviewed eight studies conducted during 2004. Overall, this research reported positive results, especially in cases of obsessive-compulsive disorder. However, the authors were quick to point out a generally poor quality of research techniques, inadequacies in methodology, and difficulty comparing studies.⁸ A Cochrane review of two RCTs that investigated the effectiveness of meditation and yoga on patients with diagnosed anxiety disorders stated that based on the available research, no distinct conclusions can be drawn on the ability of meditation and yoga to be effective for anxiety disorders.⁹

Asthma To determine the efficacy of Iyengar yoga practice on symptoms and perceived quality of life of people living with asthma, 62 patients with mild to moderate asthma were randomized and divided into two groups. The treatment group performed Iyengar yoga for 4 weeks, and the control group enrolled in a “stretching” program. Both groups underwent spirometry testing and recorded their bronchodilator use, symptoms, and quality of life assessments. At no point in the study did the yoga intervention group show a measured benefit in clinical indices.¹⁰Another small RCT divided 17 subjects into a yoga treatment and a control group. The yoga group engaged in relaxation pranayama (mindful breathing) techniques, yoga postures, and meditation 3 times per week for 16 weeks. Spirometry testing showed little difference between the two groups; however, the yoga group showed improved exercise tolerance and reported relaxation as well as a more positive attitude as measured by questionnaire. This study also showed a trend toward less use of short-acting bronchodilator medication in the yoga group.¹¹

Back pain A 12-week RCT compared viniyoga practice with conventional therapeutic back exercises or a self-help book for 101 patients with chronic low back pain. The yoga group met with one instructor for a weekly 75-minute viniyoga practice. Patients were also encouraged to practice at home daily and were given handouts and an audio CD guide. This group showed greater improvement in functional status, decreased activity restriction, and increased general health compared to the conventional exercise group or the self-help book group at 12 weeks. At 26 weeks post treatment, the conventional exercise and yoga therapy group did not show a significant difference in outcome, though at all points in time, viniyoga therapy appeared to be more effective than the self- care book. The viniyoga benefit also lasted for months after the intervention.¹²

Cardiovascular disease A systematic literature review of 70 studies published over the past two decades showed a trend toward beneficial changes in metabolic syndrome risk factors such as insulin resistance, lipid profiles, BP, and anthropomorphic indices. The author noted that by controlling risk factors for metabolic syndrome, a regular yoga practice might possibly reduce the risk of cardiovascular disease (CVD). It is important to note that approximately one-third of the reviewed studies were RCTs and that the majority of the others were uncontrolled or nonrandomized controlled clinical trials.⁴A 2002 comprehensive review of the literature on the psychophysiological effects of hatha yoga concluded that regular hatha yoga practice and a “yoga lifestyle” have the potential to benefit CVD risk indices.⁵

Cardiovascular fitness A 50-minute hatha yoga routine burns 2.2 to 3.6 kcal/min, the equivalent a very slow walk. Except in persons who are very deconditioned, this type of yoga practice alone is unlikely to have a significant training effect on cardiovascular fitness, pulmonary function, body composition, or fat metabolism.¹³ More vigorous forms of power or vinyasa yoga require a higher energy output, depending on the method of teaching and selection of asanas (postures). One recent study demonstrated a 7% increase in VO2 max after previously sedentary subjects practiced 8 weeks of yoga training.¹³However, the general consensus is that yoga does not provide the significant cardiovascular stimulus necessary to enhance cardiovascular function.¹⁴

REFERENCES

Setting boundaries

05 Friday Feb 2021

Posted by RichardB in boundaries, Handout, Uncategorized

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handouts, therapy

Setting boundaries is an essential skill in life, especially for people in recovery. Addicts often grow up in dysfunctional homes, where boundaries were either too rigid (leading to suppressed emotions or distant relationships) or too enmeshed (depriving them of a sense of personal identity). Later in life, their interpersonal relationships may continue to be defined by old roles and patterns, increasing the risk of depression, anxiety and addictive or compulsive behaviors. f-145

As part of recovery, addicts learn how to set boundaries and to respect other people’s boundaries in return. In the addiction field, treatment providers often refer to this process as embracing the authentic self. While it may sound like psychobabble, it is really a process of discovering who you want to be, how you want to interact with other people, and taking responsibility for the consequences of your choices.

Why are boundaries important? They keep you safe from being manipulated, abused or taken advantage of, while also protecting other people from harm you may consciously or unconsciously inflict. They prevent both parties in a relationship from blurring the lines between self and others, which can lead to enmeshment and codependency. With healthy boundaries in place, you can begin to tune in to your inner voice and trust your own thoughts and feelings, and then communicate those to other people.

Distinguishing Healthy and Unhealthy Boundaries

Without a healthy role model, it can be difficult to know what healthy boundaries look like. First, let’s cover what healthy boundaries are not. They are not threats or attempts to control or manipulate others into doing what you want. They are not rigid rules or “walls” designed to keep people out or shield you from expressing your emotions.

Healthy boundaries are simply a delineation of what type of treatment is acceptable to you, and what consequences will result from violating a boundary. People with healthy boundaries share their thoughts and feelings, take care of their own needs, and are able to say no when necessary.

merge-sign By contrast, people with weak boundaries often:

• Sacrifice their personal values, plans or goals to please others

• Allow others to define who they are and make decisions for them

• Expect others to fulfill all their needs

• Feel guilty when they say no

• Hesitate to share their opinions or assert themselves if they are being treated unfairly

• Frequently feel used, threatened, victimized or mistreated by others

• Frequently offer unsolicited advice, or feel pressured to follow someone else’s advice

• Take responsibility for other people’s feelings

• Tell others how to think, feel or act

A Boundary-Setting Roadmap

Every individual is called upon to set their own boundaries. What works for some may seem either too intrusive or too distant to others. When laying out your boundaries, work through the following steps:

Create a Personal Bill of Rights. Before you can start setting boundaries, you have to recognize your right to have your own feelings, values and beliefs and to express to others how you want to be treated. For some, this requires a colossal leap in self-worth.

Identify Your Emotions. Our parents always admonish us to “think before you act.” When you have a strong response, take a time-out to identify the underlying emotion and figure out what you want to convey. Doing so allows you to interact with other people in an honest, direct way rather than blaming or lashing out.

Set Limits. Once you have a few guidelines in place for how you expect to be treated, practice setting limits with people in a clear, direct way. Examples of healthy boundaries are: “I choose to be around sober people” or “I’ll be happy to talk with you when your voice is calm.”

Assert Your Needs. If you feel that your boundaries are being violated, speak up. This doesn’t mean lashing out or blaming others, but rather assertively communicating your needs. Ask for what you want and say no, politely yet firmly, if something isn’t right for you.

Listen to Your Instincts. If a situation feels uncomfortable or inappropriate, chances are a boundary is being pushed. By tuning into your instincts, you’re more likely to respond in ways that are true to your authentic self.

Defend Your Boundaries. Once you set boundaries, expect that they will be tested. Before this happens, set consequences that you are willing and able to enforce (e.g., “If you continue this behavior, I will…”). Know that by setting limits, you may disappoint the other person, especially if they have weak boundaries themselves. While you should always act with dignity and respect, you can’t control other people’s feelings and behaviors.

If someone continually violates your boundaries, you may need to minimize contact with them, or if they are toxic to your recovery, cut ties altogether. By choosing not to let people violate your boundaries, you stop being the victim, stop blaming others and start reclaiming responsibility for your own life.

Respect Other People’s Boundaries. Just as important as honoring your own boundaries is respecting other people’s, even if they are different from yours. If they don’t have defined boundaries, show them the respect you know they deserve anyway.

Thinking influences

17 Thursday Dec 2020

Posted by RichardB in Anger, Handout, Uncategorized

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anger, handouts, Thinking

Thinking influences our feelings through the things that we say to ourselves. Unhelpful thoughts can add fuel to the fire and play a large role in keeping anger going after the event has passed. However, using helpful self-statements (or ‘cooling thoughts’) can be a good way to manage our anger and guide our behavior. brainmp Examples of these include:

Chill out
Calm down
Breathe away the anger
Don’t yell
Don’t give them the satisfaction of seeing you angry
It’s not worth it
Give them a chance to have a say

To use this strategy we need to break anger into several stages:

Getting ready for provocation: when we know we are going to face something that will make us angry.
During the event: early signs of anger are cues to use coping strategies.
Coping with stress: early attempts at anger management may not be successful.
Reflecting on provocation: time to evaluate the effect of the experience on you, continue coping or give self praise.

Preparing for a provoking situations

This is going to upset me but I know how to deal with it
What is it that I have to do?
Stick to the issues and don’t take it personally
Try not to take this too seriously
Time for a few deep breaths of relaxation
Easy does it, remember to keep your sense of humor

During the event

Stay calm, just continue to relax
Think of what you want to get out of this
There is no point in getting mad
It’s really a shame that she has to act like this
If I start to get mad I’ll just be banging my head against the wall
What he says doesn’t matter. I’m on top of this situation and it’s under control

Coping with stress

My muscles are starting to feel tight, time to relax and slow things down
It’s just not worth it to get so angry
Time to take a deep breath
Try to reason it out. Treat each other with respect
He’d probably like me to get really angry. Well I’m going to disappoint him Leaving the anger and looking back
Try to shake it off. Don’t let it interfere with your job
Remember relaxation, it’s a lot better than anger
I handled that pretty well. It worked!
It could have been a lot worse
My pride can sure get me into trouble, but when I don’t take things too seriously, I’m better off

Evidence based Yoga 2

01 Thursday Oct 2020

Posted by RichardB in Health, Wellness, Yoga

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activities, ADHD, adherents, alignment, analysis, Another, asanas, assessments, asthma, attention, attitude, author, authors, Back, behavior, benefits, Both, bronchodilator, Cardiovascular, cases, Cochrane, composition, concentration, conclusions, consensus, deficit, difference, disease, disorder, disorders, efficacy, energy, Europe, Evidence, Except, factors, handouts, harmony, Hatha, health, improvement, inadequacies, India, Indian, indices, instructor, intervention, interventions, Iyengar, life, lifestyle, literature, measures, medication, medicine, meditation, metabolic, method, methodology, origins, outcome, output, Overall, pain, Patients, persons, philosophy, postures, pranayama, purposes, questionnaire, Raja, RCTs, relaxation, resistance, response, restriction, results, selection, self, sessions, Spirometry, status, stimulus, subjects, symptoms, syndrome, techniques, therapy, times, tolerance, tradition, treatment, trend, viniyoga, week, weeks

Yoga is a mind and body practice in complementary medicine with origins in ancient Indian philosophy. Part two of evidence based Yoga:

Fitness and Health

Carpal tunnel syndrome A randomized, single-blind controlled trial of 42 patients with carpal tunnel syndrome assigned subjects to either a yoga treatment group or a wrist splint group, each 8 weeks in duration. Twice a week, the yoga group practiced postures specifically designed to strengthen and stretch each joint in the upper body. Yoga participants showed improvement in grip strength, pain levels, and Phalen’s sign when compared to the wrist splint group. Nerve conduction studies were not performed.¹⁵ A Cochrane review of 21 trials that evaluated the clinical outcome of nonsurgical treatment of carpal tunnel syndrome reported that 8 weeks of yoga practice significantly reduced pain as compared to wrist splinting. The yoga was described as having a “significant short-term benefit,” though the duration of this benefit is unknown.¹⁶

Depression A 2004 review of five RCTs that evaluated yoga-based interventions for depression and depressive disorders showed some positive outcomes and no adverse effects on patients’ mild to severe depressive disorders. However, poor study design and incomplete methodologic reporting makes this interpretation preliminary.¹⁷ An RCT studying 7 weeks of yoga training in a group of breast cancer survivors showed positive changes in emotional function, depression, and mood disturbance.¹⁸ “Yoga and stress management” (in the online version of this article) provides more information on this study and others involving the effects of yoga on stress.

Irritable bowel syndrome In an RCT, treatment with loperamide (Imodium) was compared to treatment with a series of 12 yoga postures practiced twice a day for 2 months in a small sample of patients with clinically diagnosed irritable bowel syndrome. Patients underwent measurement of surface electrogastrography, and trait and state anxiety tests were administered before, during, and up to 2 months after treatment. Both intervention groups demonstrated a decrease in bowel symptoms and state anxiety.¹⁹

Menopausal symptoms In a recent pilot study, 14 postmenopausal women reported via interview and questionnaire a decrease in the severity and frequency of hot flushes after 8 weeks of 90-minute “restorative yoga” classes. Although this initial finding sounds encouraging, this trial had no control group or objective parameter measurements.²⁰ An RCT studying postmenopausal sleep quality divided 164 women into groups who participated in either 4 months of low-intensity yoga, a moderate-intensity walking program, or a wait-list control group. This study reported no statistically significant interventional effects of any treatment on total sleep quality or on any individual sleep quality domain.²¹

Multiple sclerosis An RCT of 57 subjects with clinically defined multiple sclerosis were assigned to weekly Iyengar yoga class plus home practice, a cycling program, or a wait-list control group for 6 months. Results showed that both active interventions produced significant improvement in perceived levels of energy and reduced fatigue; however, the specific effects of the yoga practice were not isolated.²² Osteoarthritis In a pilot study, 11 deconditioned, yoga naive subjects with a clinical diagnosis of knee osteoarthritis showed improvements in pain and knee stiffness after 8 weeks of yoga training. The group performed modified Iyengar yoga sessions once a week.²³

Seizure disorders In 2000, a systematic review of the published literature revealed that only one study was able to meet the selection criteria for reliable research design. The reviewers concluded that no available evidence pointed to yoga therapy as an efficacious treatment for epilepsy.²⁴

Strength and flexibility In a recent study on the fitness related effects of hatha yoga, 10 yoga-naïve and previously untrained subjects aged 18 to 27 years participated in 85 minutes of pranayama and hatha yoga practice twice a week for 8 weeks. These subjects showed significant improvement in upper and lower body muscular strength, endurance, and flexibility. No statistically significant change in body composition or pulmonary function was observed.¹³
In a partial RCT with a longer time frame, 54 subjects aged 20 to 25 years participated in either 5 months of yoga instruction or no activity. After that time period, both groups practiced yoga for an additional 5 months. The group practicing 10 months of yoga showed significant improvements in shoulder, trunk, hip, and neck flexibility, as well as a reported improved performance during submaximal exercise testing.²⁵
A well-executed study compared subjects who underwent 24 hours of hatha yoga classes over 8 weeks with a control group. The yoga training group showed a 13% to 35% improvement in flexibility, balance, and muscular endurance. The authors concluded that hatha yoga practice has significant effects on balance and flexibility.²⁶

REFERENCES

1. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005;11(1):42-49.
2. Carrico M. Yoga Journal’s Yoga Basics: The Essential Beginner’s Guide to Yoga for a Lifetime of Health and Fitness. New York, NY: Henry Holt and Company; 1997.
3. Nayak NN, Shankar K. Yoga: a therapeutic approach. Phys Med Rehabil Clin N Am. 2004;15(4): 783-798, vi.
4. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract. 2005;18(6):491-519.
5. Raub JA. Psychophysiologic effects of Hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. J Altern Complement Med. 2002;8(6):797-812.
6. Luskin FM, Newell KA, Griffith M, et al. A review of mind-body therapies in the treatment of musculoskeletal disorders with implications for the elderly. Altern Ther Health Med. 2000;6(2): 46-56.
7. Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of boys with attentiondeficit/ hyperactivity disorder (ADHD). J Atten Disord. 2004;7(4):205-216.
8. Kirkwood G, Rampes H, Tuffrey V, et al. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med. 2005;39(12):884-891.
9. Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database Syst Rev. 2006;(1):CD004998.
10. Sabina AB, Williams AL, Wall HK, et al. Yoga intervention for adults with mild-to-moderate asthma: a pilot study. Ann Allergy Asthma Immunol. 2005;94(5):543-548.
11. Vendanthan PK, Kesavalu LN, Murthy KC, et al. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc. 1998;19(1):3-9.
12. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005;143(12):849-856.
13. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha yoga practice on the healthrelated aspects of physical fitness. Prev Cardiol. 2001;4(4):165-170.
14. Clay CC, Lloyd LK, Walker JL, et al. The metabolic cost of Hatha yoga. J Strength Cond Res. 2005;19(3):604-610.
15. Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998;280(18):1601-1603.
16. O’Connor D, Marshall S, Massy-Westropp N. Nonsurgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003(1):CD003219.
17. Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005;89(1-3):13-24.
18. Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psycho Oncol. 2006;15(10):891-897.
19. Taneja I, Deepak KK, Poojary G, et al. Yogic versus conventional treatment in diarrheapredominant irritable bowel syndrome: a randomized control study. Appl Psychophysiol Biofeedback. 2004;29(1):19-33.
20. Cohen BE, Kanaya AM, Macer JL, et al. Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Maturitas. 2007;56(2):198-204.
21. Elavsky S, McAuley E. Lack of perceived sleep improvement after 4-month structured exercise programs. Menopause. 2007;14(3, pt 1):535-540.
22. Oken BS, Kishiyama S, Zajdel D, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004;62(11):2058-2064.
23. Kolasinski SL, Garfinkel M, Tsai AG, et al. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med. 2005;11(4):689-693.
24. Ramaratnam S, Sridharan K. Yoga for epilepsy. Cochrane Database Syst Rev. 2000(3):CD001524.
25. Ray US, Mukhopadhyaya S, Purkayastha SS, et al. Effect of yogic exercises on physical and mental health of young fellowship course trainees. Indian J Physiol Pharmacol. 2001;45(1):37-53.
26. Boehde D, Porcari JP, Greany J, et al. The physiological effects of 8 weeks of yoga training. J Cardiopulm Rehabil. 2005;25(5):290.