Shame Handout for Dell Childrens

Total Page:16

File Type:pdf, Size:1020Kb

Shame Handout for Dell Childrens Fall 08 Dell Children's Medical Center January 2015 Shame, Relevant Neurobiology, and Treatment Implications Arlene Montgomery Ph.D., LCSW Shame Guilt Early-forming (before age two) Must have concept of another (2 yrs+) Implicit memory (amygdala) Explicit memory (upper right & left hemi) Arousal involves entire body: Arousal is an upper cortex, primarily left, • excitement state of worry • painful arousal (SNS) • counter-regulate (PNS) • positive outcome = repair • negative outcome = no repair; lingering in PNS state Non-narrative (not conscious) Narrative (conscious experience) • a state of being: "I am something..." • "I did something" e.g., bad, worthless, flawed as a whole • an act person Runs away from further external Seeks to maintain attachments interactions, but cannot run away from the internal representations of the scorn of the other - an internal experience Shame states may engage the freeze Guilt experiences may engage the more (dissociated, passive) state or flight activated fight states ( not actually fighting, state(hiding, other avoidant behaviors) or but actively making thing right, correcting submit state(agreeing, becoming invisible, mistakes, engaging the milieu in some way complying) to manage the painful arousal to address the “bad act, moving toward…) Repaired shame is a normative socialization experience (Schore, 2003 a,b) Relational trauma may result from unrepaired shame experiences "corroded connections", (B. Brown, 2010); "affecting global sense of self" (Lewis, 1971) Issues and Diagnoses PTSD: shame is predictor of posttraumatic symptoms (Herman, 2007) Suicidality: shame schema associated with higher levels of dissociation and correlated with self-reported suicidal risk variables (Young Schema Questionnaire, Young & Brown, 1999). Borderline Personality Disorder (deals with shame and guilt, but primarily shame) • Rusch, et al, 2007, (Experiential Shame Scale, Turner) found women with BPD score higher in shame and shame- proneness (at both implicit and explicit levels) than both women with social phobia and healthy women • In Kernberg’s (1975) work the ubiquitous use of projective identification addresses the object relationship (i.e., internalized self, internalized object [i.e., the other], and linking affect) to determine which elements or parts of the elements of the object relationship might be projected. Narcissistically injured people • Kohut (1978) & Morrison (1989) describe excitement and shame as including the somatic components of blushing & avoiding eye contact (both managed by PNS), and sweating & jitteriness (SNS) Addiction • (O’Connor & Weiss, 1993) use of shame and/or guilt to hold in place pathogenic belief that inhibits achieving normal developmental goals in order to maintain the tie to the necessary relationship; pain of shame/guilt states make vulnerable to drug use as pain management Couples • Other clinicians exploring the transference of affective states (aspects of shame and guilt) include Miehls (1997), Dicks (1993), and Middelberg (2001), whose work with couples has led them to identify the reciprocal feedback loop between partners and some common, often polarized, mental contents that may be split between the partners (e.g., the pursued–pursuer of Middleberg’s discussion). Treatment Implications for addressing shame Call attention to noticed distinctive verbal, paralinguistic and nonverbal cues could alert to shame states (Herman, 2007) • Vocabulary of shame include, ridiculous, foolish, silly, idiotic, stupid, dumb, humiliated, disrespected, helpless, weak, inept, dependent, small, inferior, unworthy, worthless, trivial, shy, vulnerable uncomfortable, or embarrassed • Paralinguistic cues include confusion of thought, hesitation, soft speech, mumbling, silences, stammering, long pauses, rapid speech, or tensely laughed words • Nonverbal cues include hiding behavior, covering all or parts of the face, gaze aversion, eyes downcast or averted, hanging head, hunching shoulders, squirming, fidgeting, blushing, biting or licking lips, biting the tongue, false smiling (Retzinger, 1995 in Herman, 2007) B. Brown, like others, recommends shame and its triggers be recognized; practicing awareness; reaching out to shamed person; and speaking of shame (2012). These suggestions will regulate arousal which may persist in the implicit memory as an internal representation within the cortical & subcortical structures (Goldman-Rakic, 1987) Titrate addressing shame (Cloitre, Cohen, & Koenen (2006): to avoid reinforcing shame; striving for dignity rather than humiliated in the telling of experience of shame In dissociative disorders, shame itself is a shameful secret (Thurkus & Kahler, 2006)…psycho-education may help undo stigma and shame associated with being ill; patients on the trauma unit suggested to change the name to Psyche-education to move away from psycho, crazy, insane, etc. Transference: client expects to experience contempt, so not trust positive regard (Courtois, 1988) Counter-transference: shame, a contagious emotional with therapists uncomfortable leading to reluctance to directly confront own affects as well as client’s affects. Toxic affects (shame, guilt, envy, vulnerability, impotence, for example) may be attributed to the client via the therapist expressing sarcasm, teasing, ridiculing, and/or efforts to control the client in some way (Schore, 2003b, p.91). The therapist’s ability to recognize and regulate their bodily signals determines destructive or constructive counter- transference. Group work: emotional contagion may occur with exposure of the excitement of the shamed self-state which has preserved the grandiosity unmodulated in early dyadic experiences…sharing with others has potential to attenuate the pain of the oscillating arousal states (Nitsun, 2006, in Aledort, 2014); group work can address the power imbalance between client/therapist because of reciprocity, not so within dyad Projective Identification Adaptive Defensive (maladaptive) • baby signals distress • same process as adaptive PI, but • caregiver has synchronous somatic maladaptive if used beyond young reaction adulthood • caregiver fixes the problem • brain attempts to offload • over time, baby retrieves comforting stressful/traumatic experiences (stored memories (hippocampus) in subcortical neural circuitry, out of • neuro-circuitry developing to comfort conscious awareness) self • Ridding the brain of an affect, etc., is • hippocampus and other memory not the same as signaling distress systems o not available for conscious o eventually are available to retrieval consciousness o disorganized o narrative line o chaotic o summary form How does the ejected material actually "move" from one brain to another? "Moving" = "signal distress" if adaptive "Moving" = "ridding/offloading" if maladaptive Non-consciously, the projector chooses a vulnerable recipient The "sender" then treats the receiver in a way that causes him/her to experience what the projector is experiencing. This "offloading" is merely the sender's attribution of a trait, emotion, with, fear, etc., with which the "receiver" begins to resonate. In that moment, the receiver may have no idea of the origin of the affects. The sender can appear a bit blank (PNS) as if in a trance; if asked, the sender may appear bewildered because they are no longer experiencing the affect. Transference and Counter-transference The brain is associational, needing few cues to rapidly compare past experiences with elements of current perceptions. The brain uses a select sensory experience imprinted in the lower, subcortical regions, which are either - or in their associations involving safety and danger. If something is a little bit dangerous, the lower limbic system will experience huge danger. When Transference occurs, the client "relocates" a stressful or traumatic experience that happened in the past into the present, with the clinician. Countertransference is the clinician's nonconscious reaction to the transferred experience of being with the client. There is a bodily experience in the clinician to the imagery, affects, or thoughts that have been induced nonconsciously by the client (involving the right amygdala and the right insula). Neurobiology of Shame Shame is biologically stressful, producing elevated cortisol and ACTH responses (stress management neurochemicals) {Herman, 2007} • shame transactions produce low levels of endorphins and corticotropin releasing factor (CRF) and elevated levels or corticosteroids • stress-induced adrenocortical steroids influence gene regulation and brain growth (Beato, et al, 1987, in Schore, 2003a, p. 21) • If this low affect state persists without interactive regulation over too long a time and too many times, this type of bio-regulation of arousal may persist in the implicit memory as an internal representation within the cortical & sub-cortical structures (Goldman –Rakic, 1987). • Shame is sub-cortical (right hemisphere) in origin, involving - among other structures - the right amygdala (safety-danger; fight, flight, freeze, submit; implicit memories; flashbacks; not conscious) and the right insula (mediates bodily states; resonating with emotional states of others) • The insula and amygdala have direct connections to ANS, the up/down arousal system affecting all organs and most glands of body. The auto-regulation of the unrepaired shame-induced states heavily relies on dissociation, as the immature brain is bathed in the neurohormones and neurotransmitters that maintain the inhibitory state. • Little new learning
Recommended publications
  • Supporting Individuals with Grief: Using a Psychological First Aid Framework Barney Dunn, July 2020 My Background and Acknowledgements
    Supporting individuals with grief: Using a psychological first aid framework Barney Dunn, July 2020 My background and acknowledgements • Professor of Clinical Psychology at Mood Disorders Centre, University of Exeter and co-lead AccEPT clinic (NHS ‘post IAPT gap’ service) • Main area depression but been involved in developing some grief guidance as part of COVID response with Kathy Shear (Columbia) and Anke Ehlers (Oxford) • These materials developed to support counsellors/therapists to work with grief with principals of psychological first aid. • Thanks to Kathy Shear for letting me use some of her centre’s materials and videos Overview • Part 1: Understanding grief • Part 2: Supporting individuals through acute grief • Part 3: Use of psychological first aid framework for grief (and more generally) • Part 4: Prolonged grief disorder Learning objectives • Be familiar with range of grief reactions • Be able use your common factor skills and knowledge around bereavement from workshop to respond empathically and supportively to people who are grieving in a non-pathologizing way • Be able to use the psychological first aid framework to help people look after themselves while grieving • To know who and how to signpost on to further help • You are not expected to be experts in grief or to ‘treat’ grief Optional core reading Supporting people with grief: • Shear, M. K., Muldberg, S., & Periyakoil, V. (2017). Supporting patients who are bereaved. BMJ (Clinical research ed.), 358, j2854. https://doi.org/10.1136/bmj.j2854 • See also material for clinicians and public on this website: https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/ Prolonged grief disorder: • Jordan, A.
    [Show full text]
  • The Neural Basis of the Sense of Fatigue
    Iowa State University Capstones, Theses and Graduate Theses and Dissertations Dissertations 2020 The neural basis of the sense of fatigue Mark Edward Hartman Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/etd Recommended Citation Hartman, Mark Edward, "The neural basis of the sense of fatigue" (2020). Graduate Theses and Dissertations. 18136. https://lib.dr.iastate.edu/etd/18136 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. The neural basis of the sense of fatigue by Mark Edward Hartman A dissertation submitted to the graduate faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Major: Kinesiology Program of Study Committee: Panteleimon Ekkekakis, Major Professor Peter Clark James Lang Jacob Meyer Rick Sharp The student author, whose presentation of the scholarship herein was approved by the program of study committee, is solely responsible for the content of this dissertation. The Graduate College will ensure this dissertation is globally accessible and will not permit alterations after a degree is conferred. Iowa State University Ames, Iowa 2020 Copyright © Mark Edward Hartman, 2020. All rights reserved. ii DEDICATION This dissertation is dedicated to my mother. Thank you for all your incredible support, encouragement, and patience, especially considering that it has taken me 14 years to finish my post-secondary education.
    [Show full text]
  • Repetitive Transcranial Magnetic Stimulation [Rtms] for Panic Disorder
    Repetitive transcranial magnetic stimulation (rTMS) for panic disorder in adults (Review) Li H, Wang J, Li C, Xiao Z This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2014, Issue 9 http://www.thecochranelibrary.com Repetitive transcranial magnetic stimulation (rTMS) for panic disorder in adults (Review) Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 6 OBJECTIVES ..................................... 7 METHODS...................................... 7 Figure1. ..................................... 9 RESULTS....................................... 12 Figure2. ..................................... 13 Figure3. ..................................... 15 Figure4. ..................................... 16 DISCUSSION ..................................... 18 AUTHORS’CONCLUSIONS . 20 ACKNOWLEDGEMENTS . 21 REFERENCES..................................... 21 CHARACTERISTICSOFSTUDIES . .. 25 DATAANDANALYSES. 31 Analysis 1.3. Comparison 1 rTMS + pharmacotherapy versus sham rTMS + pharmacotherapy, Outcome 3 Acceptability: 1.dropoutsforanyreason. .33 Analysis 1.4. Comparison 1 rTMS + pharmacotherapy versus sham rTMS + pharmacotherapy, Outcome 4 Acceptability: 2.dropoutsforadverseeffects. .... 34 Analysis
    [Show full text]
  • Grief Support Groups: Preference for Online Vs
    Fort Hays State University FHSU Scholars Repository Master's Theses Graduate School Summer 2011 Grief Support Groups: Preference For Online Vs. Face To Face Kris S. Fox Fort Hays State University Follow this and additional works at: https://scholars.fhsu.edu/theses Part of the Psychology Commons Recommended Citation Fox, Kris S., "Grief Support Groups: Preference For Online Vs. Face To Face" (2011). Master's Theses. 144. https://scholars.fhsu.edu/theses/144 This Thesis is brought to you for free and open access by the Graduate School at FHSU Scholars Repository. It has been accepted for inclusion in Master's Theses by an authorized administrator of FHSU Scholars Repository. GRIEF SUPPORT GROUPS: PREFERENCE FOR ONLINE VS. FACE-TO-FACE being A Thesis Presented to the Graduate Faculty of the Fort Hays State University in Partial Fulfillment of the Requirements for the Degree of Master of Science by Kris S. Fox B.S., Fort Hays State University Date_____________________ Approved________________________________ Major Professor Approved________________________________ Chair, Graduate Council ABSTRACT Grief is a reaction to loss and will be experienced to some degree by everyone in his or her life. For most, this is a brief process lasting a few weeks or months, after which they regain their focus and return to their normal lives. For a percentage of the population, however, it is more difficult to return to normal life functions. The grieving process can further diminish low social support and social support networks. However, generally providing the opportunity to talk about their feelings is sufficient to help most work through their grief without therapy (Burke, Eakes, and Hainsworth, 1999; Neimeyer, 2008).
    [Show full text]
  • Medical Treatment Guidelines (MTG)
    Post-Traumatic Stress Disorder and Acute Stress Disorder Effective: November 1, 2021 Adapted by NYS Workers’ Compensation Board (“WCB”) from MDGuidelines® with permission of Reed Group, Ltd. (“ReedGroup”), which is not responsible for WCB’s modifications. MDGuidelines® are Copyright 2019 Reed Group, Ltd. All Rights Reserved. No part of this publication may be reproduced, displayed, disseminated, modified, or incorporated in any form without prior written permission from ReedGroup and WCB. Notwithstanding the foregoing, this publication may be viewed and printed solely for internal use as a reference, including to assist in compliance with WCL Sec. 13-0 and 12 NYCRR Part 44[0], provided that (i) users shall not sell or distribute, display, or otherwise provide such copies to others or otherwise commercially exploit the material. Commercial licenses, which provide access to the online text-searchable version of MDGuidelines®, are available from ReedGroup at www.mdguidelines.com. Contributors The NYS Workers’ Compensation Board would like to thank the members of the New York Workers’ Compensation Board Medical Advisory Committee (MAC). The MAC served as the Board’s advisory body to adapt the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines to a New York version of the Medical Treatment Guidelines (MTG). In this capacity, the MAC provided valuable input and made recommendations to help guide the final version of these Guidelines. With full consensus reached on many topics, and a careful review of any dissenting opinions on others, the Board established the final product. New York State Workers’ Compensation Board Medical Advisory Committee Christopher A. Burke, MD , FAPM Attending Physician, Long Island Jewish Medical Center, Northwell Health Assistant Clinical Professor, Hofstra Medical School Joseph Canovas, Esq.
    [Show full text]
  • The Grief of Late Pregnancy Loss a Four Year Follow-Up
    The grief of late pregnancy loss A four year follow-up Joke Hunfeld The grief of late pregnancy loss A four year follow-up Rouwreacties bij laat zwangerschapsverlies. Een vervolgstudie over vier jaar. Proefschrift Tel' verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de rector magnificus Pro£dr P.W.C. Akkermans M.A. en volgens besluit van het college voor promoties. De open bare verdediging zal plaatsvinden op woensdag 13 september 1995 om 15.45 uur door Johanna Aurelia Maria Hunfeld geboren te Utrecht. Promotiecommissie: Promotoren: Pro£ jhr dr J.w, Wladimiroff Pro£ dr E Verhage Overige leden: Pro£ dr H.P. van Geijn Pro£ dr D. Tibboel Pro£ dr Ee. Verhulst Het onderzoek dat in dit proefschrift is beschreven kon worden uitgevoerd dankzij subsidies van Ontwikkelings Geneeskunde, het Universiteitsfonds van de Erasmus Universiteit en het Nationaal Fonds voor de Geestelijke Volksgezondhcid. CIP-gegevens KDninklijke Bibliotheek, Den Haag Hunfeld, J.A.M. The grief onate pregnancy loss / Johanna Aurelia Maria Hunfeld - Delft Eburon P & L Proefschrift Erasmus Universiteit Rotterdam - met samenvatting in het Nederlands ISBN 90-5651-011-8 Nugi Trefw;: perinatal grief Distributie: Eburon P&L, Postbus 2867, 2601 CW Delft Drukwerk: Ponsen & Looijen BY, Wageningen Lay-out verzorging: A. Praamstra All rights reserved Omslagtekening © P. Picasso, 1995 do Becldrecht Amsterdam © Joke Hunfeld, 1995 Rouwreacties bij laat zwangerschapsverlics Eell vcrvolgstudie over vier jaar Contents 1 Theoretical and empirical background
    [Show full text]
  • Neurobiology of Repeated Transcranial Magnetic Stimulation in the Treatment of Anxiety: a Critical Review Stefano Pallantia,B,C and Silvia Bernardia,B
    Review 163 Neurobiology of repeated transcranial magnetic stimulation in the treatment of anxiety: a critical review Stefano Pallantia,b,c and Silvia Bernardia,b Transcranial magnetic stimulation (TMS) has been applied the posttraumatic stress disorder symptom core can be to a growing number of psychiatric disorders as hypothesized. TMS remains an investigational intervention a neurophysiological probe, a primary brain-mapping tool, that has not yet gained approval for the clinical treatment of and a candidate treatment. Although most investigations any anxiety disorder. Clinical sham-controlled trials are have focused on the treatment of major depression, scarce. Many of these trials have supported the idea that increasing attention has been paid to anxiety disorders. TMS has a significant effect, but in some studies, the effect The aim of this study is to summarize published findings is small and short lived. The neurobiological correlates about the application of TMS as a putative treatment for suggest possible efficacy for the treatment of social anxiety disorders. TMS neurophysiological and mapping anxiety that still has to be investigated. Int Clin findings, both clinical and preclinical, have been included Psychopharmacol 24:163–173 c 2009 Wolters Kluwer when relevant. We searched Medline, PsycInfo, and the Health | Lippincott Williams & Wilkins. Cochrane Library from 1980 to January 2009 for the terms ‘generalized anxiety disorder’, ‘social anxiety disorder’, International Clinical Psychopharmacology 2009, 24:163–173 ‘social phobia’, ‘panic’, ‘anxiety’, or ‘posttraumatic stress Keywords: anxiety, cortical excitability, panic, posttraumatic stress disorder, disorder’ in combination with ‘TMS’, ‘cortex excitability’, repeated transcranial magnetic stimulation, social anxiety, transcranial ‘rTMS’, ‘motor threshold’, ‘motor evoked potential’, ‘cortical magnetic stimulation silent period’, ‘intracortical inhibition’, ‘neuroimaging’, or ‘intracortical facilitation’.
    [Show full text]
  • Understanding Death, Grief, and Mourning – a Resource Manual
    UNDERSTANDING DEATH, GRIEF & MOURNING A Resource Manual Cornerstone of Hope Resource Manual | Page 1 UNDERSTANDING Death, Grief & Mourning Bereavement Resource Book CENTERS FOR GRIEVING CHILDREN, TEENS AND ADULTS 5905 Brecksville Road, Independence, Ohio 44131 • 216.524.4673 1550 Old Henderson Road, Suite E262, Columbus, Ohio 43220 • 614.824.4285 CORNERSTONEOFHOPE.ORG Table of Contents Letter from the Founders 4 Forward 5 Definitions 5 The Cornerstone Approach to Bereavement Care 6 Talking to Children 8 Suggestions for Informing Children about the Death of a Loved One 11 Preparing Children for Funerals 12 Children and Bereavement Charts 14 Manifestations of Grief in Youth 19 Common Fears and Questions of Grieving Children 20 Helping Children Cope with Grief Emotions 21 Helping Grieving Children | Suggestions for Parents 22 How Can I Tell if My Child Needs Counseling? 24 Children & Teen Resources 25 Books for Children and Teens Dealing with Illness, Grief, and Loss 25 Coping as a Family 28 Adult Grief | What You Can Expect 29 Adult Resources/Social Media Resources 30 Recommended Reading for Adult Grievers 30 “Suicide is Different” 31 “The Suicide Survivor’s Affirmation” 32 Beyond Surviving | Suggestions for Survivors of Suicide 33 Murder Loss 35 Support Group Resources 36 What Types of Help are Available? 36 Grief in the Workplace 37 Helping Employees Deal with Trauma 38 Creative Therapy Resources 39 Ideas for a Memory Box 39 Time Remembered 39 Spiritual Resources 40 Grief and the Scriptures 40 “Mountain Trip” 42 “The Power of Pain” 43 Services Offered by Cornerstone of Hope 44 Notes 46 From the Founders This book is dedicated to those who have lost a loved one, and to those who want to effectively service the bereaved in their professional or personal community.
    [Show full text]
  • Emotions of Fear, Guilt Or Shame in Anti-Alcohol Messages: Measuring
    ASSOCIATION FOR CONSUMER RESEARCH Labovitz School of Business & Economics, University of Minnesota Duluth, 11 E. Superior Street, Suite 210, Duluth, MN 55802 Emotions of Fear, Guilt Or Shame in Anti-Alcohol Messages: Measuring Direct Effects on Persuasion and the Moderating Role of Sensation Seeking Imene BECHEUR, Wesford, FRANCE Hayan DIB, Wesford, FRANCE Dwight MERUNKA, University Paul Cezanne (I.A.E. Aix-en-Provence), FRANCE Pierre VALETTE-FLORENCE, University Pierre Mendes France (I.A.E. Genoble), FRANCE We study the effects of fear, shame and guilt on persuasiveness of anti-alcohol messages among young people. We experimentally test three distinct messages, each one focusing on one of the three negative emotions using a total sample of more than a thousand students. Results show that all three messages have a positive impact on persuasion and that the stimulation of shame is very effective in the case of anti-alcohol abuse advertising directed at young people. We demonstrate that sensation seeking moderates the impact of negative emotions on persuasion in the case of fear and shame appeals. [to cite]: Imene BECHEUR, Hayan DIB, Dwight MERUNKA, and Pierre VALETTE-FLORENCE (2007) ,"Emotions of Fear, Guilt Or Shame in Anti-Alcohol Messages: Measuring Direct Effects on Persuasion and the Moderating Role of Sensation Seeking", in E - European Advances in Consumer Research Volume 8, eds. Stefania Borghini, Mary Ann McGrath, and Cele Otnes, Duluth, MN : Association for Consumer Research, Pages: 99-106. [url]: http://www.acrwebsite.org/volumes/13917/eacr/vol8/E-08 [copyright notice]: This work is copyrighted by The Association for Consumer Research. For permission to copy or use this work in whole or in part, please contact the Copyright Clearance Center at http://www.copyright.com/.
    [Show full text]
  • Is D and C Required After Miscarriage
    Is D And C Required After Miscarriage Alejandro is proper outright after abstractional Gerry high-hat his soothes observably. Wilt remains foul-mouthed: easilyshe calumniating when Vincents her moleculesis suffocative. geologised too therein? Apomictic Hanan kindle piecemeal or domesticating Then stopping for miscarriage is required and c after. Often, people do not know what to say to you. As soon as you feel normal, however, you can resume most normal exercise. Here are six positions that can help ease gas, along with alternative methods of prevention and treatment. Everybody needs with greater risk is required to do. Your health problem with medicines or two days after i have hormone that you. There is no treatment to stop a miscarriage. Get a tissue sample for testing. There is no cutting involved because the surgery happens through the vagina. There may bemany ways to react to a miscarriage. Douches should also be avoided for at least two weeks after surgery to reduce likelihood of infection. The prognosis and survival rate depends upon the stage at which the cancer was diagnosed. You will probably stay in the recovery area for a period of time and then you will go home. Doctors may use vacuum aspiration, where a small tube suctions remaining tissues from the uterus. What Is a Capsule Wardrobe? Does not handle case for dyncamic ad where conf has already been set. By continuing to use our website, you are agreeing to our use of cookies. Blogger Eva Amurri shares a personal account of the fear she felt about getting pregnant again after her heartbreaking miscarriage.
    [Show full text]
  • ELECTRICAL STIMULATION for the TREATMENT of PAIN and MUSCLE REHABILITATION Policy Number: DME 035.18 T2 Effective Date: June 1, 2018
    UnitedHealthcare® Oxford Clinical Policy ELECTRICAL STIMULATION FOR THE TREATMENT OF PAIN AND MUSCLE REHABILITATION Policy Number: DME 035.18 T2 Effective Date: June 1, 2018 Table of Contents Page Related Policies INSTRUCTIONS FOR USE .......................................... 1 None CONDITIONS OF COVERAGE ...................................... 1 BENEFIT CONSIDERATIONS ...................................... 2 COVERAGE RATIONALE ............................................. 2 APPLICABLE CODES ................................................. 3 DESCRIPTION OF SERVICES ...................................... 4 CLINICAL EVIDENCE ................................................. 5 U.S. FOOD AND DRUG ADMINISTRATION ................... 15 REFERENCES .......................................................... 16 POLICY HISTORY/REVISION INFORMATION ................ 19 INSTRUCTIONS FOR USE This Clinical Policy provides assistance in interpreting Oxford benefit plans. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage members. Oxford reserves the right, in its sole discretion, to modify its policies as necessary. This Clinical Policy is provided for informational purposes. It does not constitute medical advice. The term Oxford includes Oxford Health Plans, LLC and all of its subsidiaries as appropriate for these policies. When deciding coverage, the member specific benefit plan document must be referenced. The terms of the member specific benefit plan document [e.g., Certificate of Coverage (COC), Schedule of Benefits (SOB),
    [Show full text]
  • Cultivating Subjective Well-Being Through Positive Psychological Interventions by Bryant M
    Cultivating Subjective Well-Being through Positive Psychological Interventions By Bryant M. Stone, Southern Illinois University, Carbondale; Acacia C. Parks, Hiram College Citation: Stone, B. M., & Parks, A. C. (2018). Cultivating subjective well-being through positive psychological interventions. In E. Diener, S. Oishi, & L. Tay (Eds.), Handbook of well-being. Salt Lake City, UT: DEF Publishers. DOI:nobascholar.com Abstract: Positive Psychological Interventions are activities that have been demonstrated to cause a positive change in a population by increasing a positive variable (e.g., optimism). Although these activities come in a variety of forms and focus on a wide range of positive variables, researchers tend to concentrate their efforts on seven popular and well-researched categories of PPIs that are as follows: meaning, gratitude, strengths, savoring, optimism, empathy, and kindness. Collectively, the PPIs in these domains have been shown to alleviate depressive symptoms, increase pro-social spending and social connectedness, reduce suicidal ideation, increase subjective well-being or happiness, and many other positive changes across diverse populations. Still, there are many questions that warrant discussion for future research such as sex and cultural differences, long-term effects, and antithetical or unexpected reactions to activities. Along with examining these benefits and critiques of PPIs, we discuss the background and state of replicability for each domain. Keywords: Positive Psychological Interventions, Subjective Well-being, Self-Help The relatively new field of Positive Psychology has produced a great deal of clinically applicable research through the study of Positive Psychological Interventions (PPIs). In both self-help, research, and clinical practice, well-researched domains such as gratitude, savoring, and kindness encourage individuals to shift their focus away from negative experiences, traits, and circumstances towards the positive (Parks & Biswas-Diener, 2013).
    [Show full text]