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Kyndal,

First I would say to work with your pulmonary dr. Have you had any breathing tests done to see the severity of the asthma? Never stop taking your meds.

I was the same [U]exact[/U] way last year: I was so afraid of chest tightness and of getting a bad asthma attack. From October to December I was on sick leave from work...due more to the anxiety. I never strayed far from my apartment. I also don't like heat and humidity.

Chest tightness is a symptom of both asthma and anxiety. Since my asthma is mild, it was and still continues to be difficult to tell the difference if I am having an asthma or anxiety epsiode.

My pulmonary dr said anxiety was ruling my life. I agreed and in November 2006 I was fortunate to find free outpaitent (CBT) cognitive behavorial therapy. (I cabbed it to/from the sessions; I felt more secure in a taxi as opposed to public transportation.) CBT saved my life, reducing the anxiety so much. I fear the asthma so much less than exactly a year ago. I would like to offer here the written notes from the therapy sessions. I hope it helps you (and anyone else.)

Best regards,

John

Managing Medical Symptoms
Session One Summary Patient Handout: Shifting Attitudes
1) Old Attitude: Every symptom has a definitive medical explanation.
New Attitude: Many symptoms have no clear cause, or definitive medical explanation. This does not mean they are grave or life threatening.
2) Old Attitude: Somewhere there is a doctor who can cure my symptoms.
New Attitude: There comes a point where I can choose to stop seeking a medical explanation and cure, accept that my symptoms may not go away, and start to learn to cope with my symptoms.
3) Old Attitude: Unless I get rid of my symptoms completely, I won't feel any better at all.
New Attitude: I can decrease discomfort and improve the quality of my life by changing my beliefs, assumptions, and feelings about my symptoms. I can learn to interpret symptoms in non-frightening and more realistic ways.
4) Old Attitude: Good health means being symptom free. So, if something is wrong, it must be a disease.
New Attitude: Even healthy people experience sensations and symptoms regularly. Many symptoms are caused by normal bodily changes in response to activity, stress, emotions, and other benign causes. I can learn to accurately label these sensations then ignore them.
The way in which I interpret and think about sensations and symptoms greatly influences how intense and disturbing they seem. The more threatening I believe the cause to be, the more I will experience the symptom as painful. Symptoms I believe to have "normal" causes will seem much less intense than symptoms I attribute to disease.
5) Old Attitude: If my doctor has not found a cure for me yet, he/she must not be that concerned about me or my medical problems.
New Attitude: My doctor takes my concerns seriously, and wants me to feel better. However, there are limits to medical knowledge, and not all symptoms have known cures. There are other ways to cope with these symptoms effectively, even if they cannot be cured.
***How to make this information work for you***
Consider how each attitude might apply to your target symptom. Is there an attitude that contributes to your distress and that you now feel ready to challenge? Select one of the new attitudes to start practicing with your symptoms. Be patient as you test it out several times and reinforce the new belief.

Managing Medical Symptoms
DIAPHRAGMATIC BREATHING
Session One Patient Handout
Points of Emphasis
1) You can practice diaphragmatic breathing in a seated or lying position. Eventually you will be able to use relaxed breathing even while standing or moving. Choose a position with your back supported and straight, avoid being bent at the waist. Wear loose clothing so your waist and abdomen can expand freely.
2) Practice diaphragmatic breathing for ten minutes twice a day to start. Practice the diaphragmatic breathing technique for a few minutes, take a break to breath as you normally do, then return to a few minutes of diaphragmatic breathing. You do not need to do the ten minutes continuously in the beginning.
3) If you feel dizzy or lightheaded, or you feel tingling in your lips or fingertips, stop practicing and go back to your regular way of breathing until those sensations pass. Review the instructions before your next practice session, and take care to avoid hyperventilating or overbreathing.
Diaphragmatic Breathing Instructions
1) Choose a comfortable position, and loosen any tight clothing. Relax the muscles of your shoulders, back, and chest. Most important, relax your belly, so it can expand with each breath.
2) Breathe in through your nose to warm and filter the air. Breathe out through your mouth, with lips pursed to hold the air passages open longer. Once you are comfortable with this technique, you can inhale and exhale through your nose.
3) Place your hand lightly on your abdomen, just above the navel.
4) Exhale slowly through pursed lips while gently pressing on your abdomen. This empties the lungs, and makes room to inhale fresh air.
5) Now begin the cycle: inhale slowly and easily through the nose. Pause for a second. Now exhale slowly and completely through the mouth with lips pursed. It may take longer than you expect! It takes about twice as long to exhale as it does to inhale. Pause, then begin the next cycle as your body begins to inhale. Take all the time you need for each breath in, and each breath out.
6) It may take several breaths before you feel your breath flowing easily and deeply. You will begin to feel your hand rise about an inch or so when you inhale, and then fall every time you exhale. Inhale, belly rises and hand rises; exhale, belly falls, hand lowers. Your aim is to settle into a smooth, even rhythm. Don't worry about moving large amounts of air in and out of your lungs. The even, rhythmic flow is more important.
Try A Mental Focus
Once you have the basic movements down, you might like to add a mental focus. Experiment
with a few different types of mental focus techniques to see which one you prefer.
1) Imagine that there is a balloon right behind your navel. As you inhale, the balloon inflates,
your belly expands out. As you exhale, the balloon deflates, your belly flattens as the air flows
out.


2) You might like to imagine your breath flowing like the gentle waves of the ocean, flowing into the shore and then flowing back out again... a smooth, even rhythm, very soothing and relaxing.
3) You can repeat a phrase with each breath. For example, inhale, exhale and say "relax" or "let go."
4) Count from one to four as you inhale, then from one to four as you exhale.
Be patient and keep up your practice! If you have questions, bring them to the next session.

Managing Medical Symptoms
Session Two Summary
Patient Handout
Attention
Attention is one of the main influences on how we feel physically. The amount of attention we pay to symptoms influences how intense the symptoms feel. The more attention we direct to a symptom, the more it hurts or bothers us. For example, banging your shin on a chair while you are home alone will be more painful than banging your shin while skiing with friends. In the latter case, you would be distracted by having fun and being with friends so you would hardly notice the injury. While home alone, you would focus intently on the painful sensation and blossoming bruise.
Attention is also one of the main influences on how we feel emotionally. Focusing on a symptom raises your anxiety level. The more one focuses, the more serious and worrisome the symptom becomes. When intense attention is combined with anxiety, physical changes take place that make it seem that the symptom is getting worse, even though the cause of the symptom remains the same.
Just as increasing the attention you give a symptom increases sensitivity and discomfort,
lessening the attention you pay will lessen discomfort. Distraction is an effective way to shift
your attention away from unpleasant physical sensations and worrisome thoughts.
Many people have developed a fine-tuned sensitivity to what goes on inside their body. This sensitivity contributes to unpleasant sensations and worry. The good news is that the same sensitivity will make it easier for you to learn relaxation. Relaxation training helps reduce stress and anxiety.
***How to make this information work for you***
Select a symptom that has been checked out by your doctor and for which no serious cause has
been found. Rate the symptom on a scale of 1-5, with 5 being most bothersome. For five
minutes, focus intently on the symptom, imagining the cause and what is going on inside. Let
the worried thoughts you often have come in. Then rate the symptom from 1-5 again. Which
direction did your rating go? .
Now select a distraction technique, and practice it for 10 minutes. Rate your symptom one last
time. Did your ratings change?
When you notice yourself focusing attention on a symptom, take a break to practice relaxation or to distract your attention. The goal is to break the cycle of symptom perception by reducing attention, anxiety, and the frightening meaning attached to the symptom. Even if the symptom doesn't go away, you will feel more in control and less bothered.


Managing Medical Symptoms
Session Two
Patient Handout: Distraction Techniques
Distraction can redirect conscious awareness away from bothersome sensations and repeated
worries. A number of techniques are described below, but any constructive, absorbing activity is
a good choice.
1) Go through the alphabet, naming varieties of soup, i.e., A = asparagus, B = bean, C = cream of mushroom. Name all 50 States.
2) Do a simple task such as washing dishes, watering plants, fix something. Give the activity your full attention.
3) Spend time on an enjoyable craft project: knitting, needlepoint, woodworking, stringing beads. Write in a journal, draw, doodle, or paint.
4) Focus on the outside world. Stand by a window and count the cars going by. Describe the changes you notice in your garden or front yard since last week.
5) Replay a happy moment in your memory as if watching a movie. Use all your senses to make the scene come alive, i.e., try to imagine the temperature, the sounds around you, the quality of the light, a breeze, etc.
6) Try rhythm. Sing along with the radio, drum with your fingers, recite poetry, or pet a cat.
7) Concentrate on planning an activity you are looking forward to.
8) Games are a great distraction: computer games, cards, crossword puzzle, word games.
9) Telephone someone who has a good sense of humor. Deliberately avoid talking about
symptoms or health. .
10) Take a warm bath or shower. Focus on the scent of the soap, the comfort of a fluffy towel. Make it a pleasurable experience.
11) Exercise or take a walk.
12) Massage your face/neck/hands/shoulders/feet with fragrant lotion.


Managing Medical Symptoms
Patient Handout: Brief Relaxations
Session Two
Brief relaxations are additional ways to use the diaphragmatic breathing technique to give you the opportunity to reduce bodily hyperarousal, step away from a stresso^ and refocus on a healthier perspective. Brief relaxations work best when scheduled into your day at frequent intervals, every 1-2 hours.
These relaxations are easy to do even if you are new to relaxation:
1) Countdown breathing: Close your eyes or gaze softly at the floor. Take a breath in, and as you exhale, say "Ten." Take another breath in, a little slower and deeper. As you exhale, say "Nine." Continue counting down to zero with each breath. Feel the tension draining out of your body with each exhalation.
2) At work in a busy office, pick up a telephone and put it on hold. Take a few relaxed breaths,
drop your shoulders, and straighten your back. Or, pick up a piece of paper, pretend to read it,
but actually just focus on one word on the page as you take several relaxed breaths. You can
also try standing by a window, daydreaming about being in a special place far away from here,
while relaxing your breath and body for a few moments.
3) Five minute breathing break: Sit in a comfortable position; close your eyes and direct attention to the breath. Take smooth, diaphragmatic breaths. Think about nothing but the air flowing in and out of your body. As you inhale, say "Relax." As you exhale, say "Let go." After 5 minutes, stand up, stretch, and smile





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