Stress management therapy effectively prevents MS brain lesions

By Loren Grush

Published July 12, 2012

FoxNews.com

For those suffering from the autoimmune disorder multiple sclerosis, life alternates between almost
symptomless periods of time and episodes of intense neurological problems that can result in anything from
painful muscle spasms, loss of vision or problems moving arms and legs.
These flare-ups are often preceded by brain lesions, scars that form in the nervous system and destroy myelin
sheath material that surrounds neurons responsible for carrying electrical signals. By managing the
development of these scars, patients with MS can keep better control their episodes.
And now, new research has shown that a weekly stress management program was very effective in preventing
the development of new lesions, pointing toward possibly supplemental therapy that could be used with existing
MS treatments.
The study, published in an issue of Neurology, the medical journal of the American Academy of Neurology, is
part of ongoing research from principal investigator David Mohr, professor of preventive medicine at
Northwestern University Feinberg. A previous study of Mohrs involved following MS patients receiving MRIs
and the stressful events in their lives; stress was found to be a good predictor of the development of brain
lesions.
Stress less, reduce depression
While the results are comparable to results seen from current MS treatments, Mohr cautioned against stress
management replacing prescribed medications.
I would not want to see patients go off medications, Mohr urged. Some of the patients we had in trial were
on active medication, and we looked at whether there were differences in effects between those on medication
and those who werent, and there were no differences. What that means is that the underlying processes of how
stress management works is independent of the medications, so this is not a substitute.
In order to better understand just how effective stress management can be, Mohr hopes for a much longer, more
extensive clinical trial. Even if the results are consistent with these findings, Mohr noted that stress
management therapy is already very beneficial for MS patients.
This stress management programis highly effective for treatment of depression, reducing fatigue and
improving quality of life, Mohr said. There are a lot of reasons that people with MS would want to use this
kind of treatment. If we do a larger trial and see it is in fact useful for reducing the number of new
exacerbations, it would be a potentially useful adjunct treatment for people experiencing a lot of stress.
Read more: http://www.foxnews.com/health/2012/07/11/stress-management-therapy-effectively-prevents-msbrain-lesions/#ixzz2bG4ZdNvf

Critical Incident Stress Debriefing - Helpful or Harmful?

by Tod SchimelpfenigWilderness Medicine Institute of NOLS

July 04, 2004

Thirty years ago, when I first started working as an EMT, there was little attention given to managing the stress
of the profession. We coped with stoical silence in a culture where there was no acceptable way to deal with the
emotional impact, sadness and tragedy we experienced. We rarely talked about our experience and there were
very few wise veterans who could guide us through tough times.
At this time we began to hear of Post-Traumatic Stress Disorder (PTSD), an anxiety disorder secondary to a
traumatic event. We learned that symptoms of stress such as hyper arousal (difficulty sleeping, irritability,
trouble concentrating, hyper vigilance, exaggerated startle response), detachment, excessive alcohol or drug use,
intrusive thoughts and dreams could persist beyond the natural expected adjustment period. If not resolved,
these could become PTSD.
The emergency community recognized a need and began to develop ways to help each other cope. At first the
process was focused for emergency medical services, fire or law enforcement. Later, as outdoor programs
became more aware of the stress in our profession CISD spread into wilderness education and was used for
difficult evacuations and serious incidents.
Our CISD process was a model developed by paramedic Jeffery Mitchell. In these debriefing sessions
emergency personnel reconstruct and verbalize their participation in a critical incident and openly discuss their
feelings and reactions with peers and mental health personnel.
The steps for a CISD (Mitchell Model)

Introduction: confidentiality, not required to speak, not an investigation or critique.

Fact phase: Who are you? What was your role?
Thought phase:Your first thought after the incident?
Reaction phase: Participants discuss their reactions to the event.
Symptom phase: Signs and symptoms of stress.
Teaching phase: Education on stress management.
Re-entry phase: Identifying support systems, initiating follow-up.

Initially we helped emergency personnel through awful events that met thresholds for a critical incident: death
or serious injury to children, line of duty death, multi-casualty incidents, community disasters, prolonged and/or
night operations and threat of personal injury or death
We knew we didn't have evidence supporting the effectiveness of the CISD. To the skeptic we explained our
assumption that a critical incident stress debriefing (CISD) would prove helpful, not harmful, and prevent the
emergence of PTSD.
Mitchell responds that the critical studies compare apples to oranges. They inappropriately relate CISD to
psychotherapy and include debriefing processes that incorrectly focus on CISD while ignoring the full scope of
critical incident stress management (CISM). Single session debriefings, sessions with non-cohesive groups,
sessions for individuals and sessions with people poorly trained or straying from the model are not CISM/CISD.
Fellow CISD debriefer and NOLS Professional Training Director John Kanengieter says it well. We should
provide emotional support to the staff and participants, many of whom are young and may be experiencing their
first real life stress. The National Association of EMS Physicians, recommends psychological first aid." This
entails listening, empathy, assessing needs, ensuring that basic physical needs are met, protecting from
additional harm, not forcing people to talk and accessing family or significant others. Rescuers should
understand that their reactions, while uncomfortable, are natural, normal reactions to abnormal events, and that
healing may take time and assistance. NOLS has a plan for professional mental health support for those in need.

Thirty years ago we endured the strains of our profession because we didnt know any better. Today were more
aware, and we have more resources to help. We can use a simple, voluntary debriefing, or a conversation around
the campfire with a trusted mentor or friend to help each other manage the emotions of an event, to connect
people with their support groups, and to identify a person who needs additional help. And we can do this
without imposing a process that may not be needed, and may be harmful.

The Importance of Parenting Skills

By Mike McQuillian
Parenting is one of the most important challenges facing society, according to the British Medical Journal
(BMJ). Good parenting skills can aid in deterring childhood accidents and illness, adolescent substance abuse
and teen pregnancy. They can also reduce the risk of problems in adulthood and the next generation of children,
according to BMJ. The important role of parenting has caused governments around the world to make it a high
priority.
Adversity
Parenting skills can be used as a buffer against adversity or a mediator of damage, according to BMJ. Good
parenting can protect children from harm by keeping them out of poverty when possible and steering them away
from delinquent influences. The care involved in good parenting will promote emotional and physical health in
children. A part of good parenting is optimizing a child's potential, which will lead him to becoming a
productive member of society in the future.
Motivation
The motivation to protect and nurture children is not inborn in humans, according to BMJ. Good parenting
skills are acquired through knowledge gained from past experiences and current circumstances. Adversity faced
by parents, such as depression or poverty, can disrupt this acquisition. Working to gain these skills is very
important in these situations, as even more potential for harm to children is present when parents face adversity.
Decline in Parenting Skills
A complex and extensive social organization is available to help with child and family difficulties, according to
BMJ. The lot of the disadvantaged is rarely changed by this organization, however, which makes these
difficulties seem even worse, according to the journal. Health, social and education services rarely work
together with parents, leaving the parents feeling like mere bystanders to their child's development.
Professional Response
Good parenting skills are crucial, as they can work as a preventative measure against children's problems,
according to BMJ. Professional venues do exist to help children, but the measures they take are largely reactive
to problems that already exist. Children's problems often get worse with time, and professional reactive
measures often become less effective over time.
Doctors
Pediatricians and general practitioners can play a huge part in the development of good parenting skills,
according to BMJ. Their support of parents learning such skills will result in more children receiving the help
they need, both in maintaining their health and other aspects of childhood. These doctors can identify children at
risk of health issues so preventative measures may be taken, according to BMJ.