By Y. Hamid. Lynn University.

In the thousands of patients I have examined through the years I have rarely found the involved muscles to be in spasm buy caverta 50mg free shipping. Wolfe in a paper published in 1952 titled “Life Situations purchase 100mg caverta with amex, Emotions and Backache,” published in Psychosomatic Medicine (Vol. It is of great interest that both muscle spasm and this chemical buildup can be observed in long-distance runners, whose muscles suffer from oxygen deprivation. The presence of muscle pain, either felt spontaneously or induced by the pressure of an examiner’s hand, means that the muscle is mildly oxygen deprived. The Physiology of TMS 65 Trigger Points The term trigger points, which has been around for many years, refers to the pain elicited when pressure is applied over various muscles in the neck, shoulders, back and buttocks. There is some controversy over what precisely is painful, but most would agree that it is something in the muscle. Rheumatologists, who have taken the lead in studying fibromyalgia (TMS), appear to avoid using the term, probably because of its association with other diagnoses through the years. I neither use it nor avoid it, for I have concluded that these points of tenderness are merely the central zones of oxygen deprivation. Further, there is evidence that some of these points of tenderness may persist for life in TMS-susceptible people, like me, though there may be no pain. In the first chapter the point was made that most patients with TMS will have tenderness at six key points: the outer aspect of both buttocks, both sides of the small of the back (lumbar area) and the top of both shoulders. These tender points, trigger points, call them what you will, are the hallmark findings in TMS and they are the ones that tend to persist after the pain is gone. It is an important part of the physiology of TMS to know that the brain has chosen to implicate these muscles in creating the syndrome we know as TMS. If the brain intends to create a state of oxygen deprivation it will do so regardless of how oxygen-rich the blood is.

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In this chapter 100mg caverta with amex, we offer a snapshot of an ever-evolving approach to couple therapy that we call emotionally focused therapy generic caverta 100 mg fast delivery. We highlight the specifics of the approach and try to take the reader in-session as the couple begins to share moments of happiness and despair. EMOTIONALLY FOCUSED COUPLES THERAPY Essentially, EFT offers a brief systemic approach to changing distressed couples’ rigid interaction patterns and emotional responses and enhancing the development of a secure bond (Johnson, 1996; Johnson & Denton, 2002). This approach targets absorbing affect states that organize stuck patterns of interaction in distressed relationships (Gottman, Driver, & Tabares, 2002; Heavey, Christensen, & Malamuth, 1995). These patterns become self- reinforcing, often taking the form of critical pursuit followed by distance and defensiveness; EFT combines an experiential, intrapsychic focus on inner experience with a systemic focus on cyclical interactional responses and ensuing patterns. It is a constructivist approach in which clients are 182 THEORETICAL PERSPECTIVES ON WORKING WITH COUPLES seen as the experts on their experience. Key elements of experience, such as attachment needs and fears, are unfolded and crystallized in therapy ses- sions. Rather, they are viewed as struggling with problems arising from a particular social context that would likely be just as problematic for the therapist to deal with if she found her- self there (Neimeyer, 1993). To achieve these goals, EFT integrates key elements of client-centered therapy (e. Attachment theory (Bowlby, 1969, 1988) provides EFT with a developmental nonpathologizing theoretical context for understand- ing the importance of emotional bonds, interdependency, and adult love and intimacy. A brief overview of principles from these theories that have im- pacted EFT follows. SYSTEMS THEORY ROOTS Systems theory places an emphasis on the power of present interactions, especially patterned sequences and feedback loops, to direct and prohibit individual behavior (Watzlawick, Beavin, & Jackson, 1967). Systemic thera- pists make in-session process assessments based on present sequences of interactional behavior. The therapist is active and directive, using such in- terventions as reframing and creating enactments between family mem- bers (Butler & Gardner, 2003). The systemic therapist uses shifts in intensity to modify current problematic patterns within the family.

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