Depression & Anxiety: Evaluation & Behavioral Treatment in Chronic Pain

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2 Depression & Anxiety: Evaluation & Behavioral Treatment in Chronic Pain Kenneth J Devlin, MA Licensed Psychologist Center for Pain Relief St. Mary s s Medical Center 2

3 Changing West Virginia Reduce: Chronic disease Obesity Mood/anxiety disorders Work injuries Absenteeism Medical & insurance costs Motor vehicle accidents Improve: School performance Overall health Cognitive functioning Work performance Quality of life Overall mortality rates 3

4 Health Psychology An Integrated Approach 4

5 The Island Where People Forget to Die The New York Times By Dan Buettner 5

6 S L E E P Our Repair & Maintenance Cycle 6

7 Snooze Alert Insomnia & Cardiovascular Health Normal sleep decreases heart rate blood pressure by 10%. The absence of this reduction increases the risk for: Stroke Angina Irregular rhythm Heart attack Congestive heart failure Lack of sleep may trigger the release of increased: adrenaline, cortisol, & other stress hormones during the day, increasing the risk for heart disease. Your Guide o Healthy Sleep U.S. Dept. of Health and Human Services National Heart, Lung, and Blood Institute 7 NIH Publication No November 2005

8 Normal sleep: Snooze Alert Sleep & Hormones Increases release of growth hormone (growth, muscle mass, tissue & cellular repair). Impacts the release of sex hormones, encouraging puberty & fertility Encourages production of cytokines helping immune functioning. Lack of sleep can reduce the body s response to flu vaccine by up to 50% reduction in flu antibodies. Increases production of leptin an appetite suppressant. Decreases production of grehlin, an appetite stimulant. Your Guide o Healthy Sleep U.S. Dept. of Health and Human Services National Heart, Lung, and Blood Institute NIH Publication No November

9 Sleep Deprivation Impairs Cognitive Abilities & Mood Memory impairment results from fragmented sleep architecture Attention maintenance & task completion Mood impairment > ½ of adults report EDS results in problems with concentration, problem solving & decision making at work. 9

10 Health Consequences of Inadequate or Poor Sleep Body systems associated with major diseases such as diabetes function less effectively. Hormonal changes can accelerate the paunch process and lead to obesity. 10

11 Snooze Alert Sleep & Diabetes Study: healthy young men slept 4 hrs/night for 6 consecutive nights: Insulin & blood sugar levels mimicked those seen in people who were developing diabetes. Study: women who slept less than 7 hrs/night were more likely to develop diabetes over time than women who slept between 7-8 hrs/night. Your Guide o Healthy Sleep U.S. Dept. of Health and Human Services National Heart, Lung, and Blood Institute NIH Publication No November

12 Snooze Alert Chronic insomnia: negative consequences for health & functioning of adolescents. Insomnia is common & chronic in adolescents. The burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive, & substance abuse disorders. Chronic insomnia severely impacts future health & functioning. Primary care might be a venue for screening & early intervention. Roberts RE, Roberts CR, Duong HT. J Adolescent Health 2008 Mar, 42 (3): Epub 2007 Dec Mar, 42 (3): Epub 2007 Dec

13 Behavioral Treatments for Insomnia Stimulus Control Sleep Restriction Cognitive Behavioral Therapy Relaxation Training 13

14 Case Study Rapid resolution of intense suicidal ideation after treatment of severe OSA 74 yr old m: excessive daytime sleepiness; poor quality n. sleep; depressed mood; suicidal ideation with active plan. Declined psychiatric hospitalization. Trial with CPAP based on urgent sleep study findings of OSA. Declined antidepressants. Excellent CPAP compliance. Suicidal ideation and depression resolved promptly. Symptom remission continued on 4 month follow up. Krahn LE, Miller BW, Bergstrom LR. J Clinical Sleep Med 2008; 4(1):

15 Snooze Alert Sleep & Fibromyalgia Fibromyalgia patients invariably reported disturbed sleep (11). Even if they report 8 to 10 hrs of continuous sleep they wake up feeling tired. Most relate to being light sleepers, being easily aroused by low-level noises or intrusive thoughts. Many exhibit alpha-delta EEG pattern (12) but this is not invariable an nor is it specific (13, 14, 15). The experimental induction of alpha-delta sleep in healthy individuals has been reported to induce musculoskeletal aching and/or stiffness as well as increased muscle tenderness (16). Clinical Cornerstone Sleep Disorders and Chronic Insomnia Vol. 6, Supplement 1C (2004) Timothy Roehrs, Ph.D., Director of Research Thomas Roth, Ph.D., Chief, Division of Sleep Medicine Sleep Disorder & Research Center Henry Ford Hospital and Dept. of Psychiatry & Behavioral Neurosciences Wayne State University School of Medicine Detroit Michigan 15

16 Snooze Alert Erectile Function & Sleep Related Disorders Hormonal, neural, & endothelial mechanisms have been implicated in linking sleep disorders to ED Treatment of sleep disorders, specifically sleep apnea with CPAP has been shown to improve erectile dysfunction. Jankowski JT, Seftel AD, Strohl KP. J Urology 2008; 179 (3):

17 Snooze Alert Sleep may better predict longevity than smoking, exercise, hypertension, or hypercholestrimia. William C. Dement, M.D., Ph.D. and Christopher Vaughan The Promise of Sleep New York Delacorte Press,

18 Exercise & Mood Leisure-time exercise can offer reliable reductions in anxiety while also promoting feelings of wellbeing In one study, 10 weeks of exercise min./day, 3 times per week for patients with panic disorder resulted in almost the same benefit as treatment with the clomipramine. Cognitive-behavior therapy for panic disorder, social phobia, or generalized anxiety, can extend the gains of the above. Michael Otto, Ph.D. and Jasper Smits, Ph.D Exercise for Mood & Anxiety Disorders: Proven Strategies for Overcoming Depression and Enhancing Well being 18

19 Exercise & Mood A review of studies stretching back to 1981 concluded that regular exercise can improve mood in people with mild to moderate depression. It also may play a supporting role in treating severe depression. A study, published in the Archives of Internal Medicine in 1999, divided 156 men and women with depression into three groups. One group took part in an aerobic exercise program, another took the SSRI sertraline (Zoloft), and a third did both. At the 16-week mark, depression had eased in all three groups. About 60% 70% of the people in all three groups could no longer be classed as having major depression. Besides lifting your mood, regular exercise offers other health benefits, such as lowering blood pressure, protecting against heart disease and cancer, and boosting self-esteem. How often or intensely you need to exercise to alleviate depression is not clear, but for general health, experts advise getting half an hour to an hour of moderate exercise, such as brisk walking, on all or most days of the week. Special Health Report from Harvard Medical School "Understanding Depression". 19

20 Making It Work Education Motivation Cognitive Behavioral Strategies 20

21 Evaluation & Behavioral Treatment of Anxiety & Depression in Chronic Pain Kenneth J Devlin, MA Licensed Psychologist Center for Pain Relief St. Mary Mary s Medical Center 21

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