Open Access Journals

Students and therapists often ask us about where to go to get current research. There are of course the old favourites of PubMed and ScienceDirect. What many people don't realise is that there are a plethora of highly respected peer reviewed journals whose content is available for free on the web. These are known as 'open access journals'. As there are literally thousands of such journals available searching for them can be daunting. The good news is that there are two very good directories that list these journals and provide links to their respective websites.

The first is the Directory of Open Access Journals. This gives a comprehensive list of all scientific and scholarly open access journals available.

The second is BioMed Central. The list here is more focused on science, technology and medicine.

Both have very good search facilities that allow you to search through their entire catalogue of journals looking for relevant articles. Have a look around and enjoy the wealth of knowledge to be found for free on the internet.

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Typical Calories Used in Exercise

Ever wondered how many calories are used up in exercise? Here's a brief guide that you and your patients may find useful:

Typical number of calories used
                                                                                  
Running (calories per hour at 8-minute mile pace)                    913

Swimming (calories per hour for continuous laps)                    730

Uphill walking at a 10% gradient (calories per hour )               694

Rowing (calories per hour at a moderate pace)                        611

Cycling (calories per hour at 12-14mph pace )                         584

Jogging (calories per hour at 12-minute mile pace)                  511

Walking (calories per hour at 15-minute mile pace)                  365

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Fat Burning Exercise Tips to Help Your Patients

As we all know, one of the not-so-secret secrets of effective weight management is to exercise regularly. To that end, here are some exercise tips to help your patients burn off some of that excess fat. Of course, your patient must always check with their doctor that it is safe for them to take up more exercise.

Be intense with your exercise
Don’t be fooled by the so-called fat-burning zone. This is the misguided notion that working at a lower intensity is better for fat burning than working at a higher effort level (say, for example, walking instead of running.) The harder you exercise, the more calories you will burn and it is this that really counts when it comes to losing fat.

Choose your exercise carefully
There is no such thing as the ‘ultimate’ calorie-torching activity. Energy burned is dependent not just on the activity itself, but on how much effort you put in, how skilled you are at it, how long you do it for, and how often. So choose something that you are going to do regularly and consistently. That means an activity that you actually enjoy (unless you want your workouts to involve untold misery and boredom!) and one that is practical and accessible.

Exercising larger muscles
Serious fat-burning activity uses the large muscle groups of the body – the thighs and bottom, chest and back. The greater the overall recruitment of muscle, the higher the calorie expenditure. So in the gym, you are much better off using, say, the rower than one of those arm-cranking machines.

Sustainable exercise development
To fire up the calorie furnace, fat-burning activity has to be sustainable for a reasonable period. So while skipping is great exercise, it’s not much use if you can only do it for three minutes. The American College of Sports Medicine recommends 20-60 minutes per session, three to five times per week. It doesn’t have to be continuous effort, however …

Interval training
Interval training, in which you mix hard efforts with bouts of recovery, is one of the best ways of maximising calorie expenditure, improving aerobic fitness and making use of limited time. To get the most out of an interval session, ensure that you work outside the comfort zone on the efforts and ease right off during the recoveries. Try a 2:2 rest/work ratio to start with.

Carry the exercise load
Activities that are weight bearing, such as walking and running, use more calories than those in which your weight is supported (such as swimming or cycling), simply because you have to shift your own body weight against gravity.

Running on empty?
You may have heard that exercising on an empty stomach in the morning burns more fat. It is true that the body has to rely on fat stores if you don’t break the overnight fast, but then again, the lack of a ready energy supply may mean that you don’t work out for as long, or as hard, as you may have otherwise done.

Go for the afterburn
One of the best things about exercise is that the fat-burning benefits continue long after you’ve got out the shower. This ‘afterburn’ (increased calorie expenditure) is far greater following exercise at 75% of maximum heart rate, or higher – another reason to eschew those low-intensity workouts!

Increase exercise intensity
If you want to keep seeing results in your fat-burning programme, you must keep increasing the intensity. This isn’t the same as increasing your effort, because as you get fitter, your body will be able to cope with increasing demands. If you rest on your laurels, the benefits will begin to tail off.

Keep moving
Maximise your daily fat burning by moving! Researchers at the Mayo Clinic have found that leaner people tend to stand and move more than overweight people in normal daily life. Their ‘non-exercise activity thermogenesis’ (NEAT) was as much as 350 calories higher each day. So don’t just sit there, wiggle your toes, shake a leg, get up regularly and move your body!

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Top Tips For Mental Wellbeing

The Mental Health Foundation in the UK recently released the following tips for improving mental well being. They are worth reading as they can provide a template for that feel good factor not only for ourselves, but for our patients too:

• Eat a balanced diet and drink sensibly: Improving your diet can protect against feelings of anxiety and depression. 

• Maintain friendships: Just listening and talking to friends who are feeling down can make a huge difference. So make sure your devote time to maintaining your friendships both for their sake and your own.

• Maintain close relationships: Close relationships affect how we feel - so nurture them and if there is a problem within a relationship, try and resolve it.

• Take exercise: The effects of exercise on mood are immediate. Whether it is a workout in the gym or a simple walk or bike ride, it can be uplifting. Exercise can also be great fun socially.

• Sleep: Sleep has both physical and mental benefits. Physically it is the time when the body can renew its energy store but sleep also helps us to rebuild our mental energy.

• Laugh: A good laugh does wonders for the mind and soul.

• Cry: It is good to cry. Even though it may feel terrible at the time, a good cry can release pent up feelings, and people often feel better afterwards.

• Ask for help when you need it: The longer you leave a problem, the worse it will get. Don't be scared to ask for help from a family member, friend or professional.

• Make time for you: Do you sometimes feel like you have no time for yourself?

• Make time for your hobbies and interests.

• Remember, work isn't everything: Ninety one million working days a year are lost to mental ill-health in the UK so take it easy.

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Hypnosis and Food Intolerance

Originally written for FoodsMatter.com

In recent years the field of mind body medicine (known as psycho-neuro-immunology or PNI) has been gaining wider recognition. Clinicians are now realising that the Cartesian dualist viewpoint with regard to medicine and healing (that the mind and body are separate entities that do not communicate) is no longer applicable, and that a holistic approach to the treatment of a patient is desirable.

Increasingly the patient’s emotional state, beliefs, etc. are being addressed as part and parcel of their treatment package. This not withstanding, it has been known for a long time that emotional factors play an important role in the course of disorders of the intestinal tract and that to treat conditions such as irritable bowl syndrome, food intolerance and food allergy, psychological stability and well-being needs to be attained.

From this position the realisation that other gastrointestinal disorders (as well as organic disorders in general) will benefit from the alleviation of psychological upset has become widely acknowledged, and that both positive and negative emotional factors can and do influence the functioning of our immune system (the part of our body responsible for maintaining our health). Many clinicians are now recommending that some form of psychological intervention accompany standard treatment approaches and much has been written in the scientific press detailing the efficacy of such interventions. These studies have also shown that the hypnotherapeutic approach is particularly effective in alleviating symptoms, improving quality of life, and reducing absenteeism from work.

What is hypnosis?
The use of hypnosis as a therapeutic tool has a very long history. The earliest recorded examples are found in the sleep temples of ancient Egypt where archaic hieroglyphs detail procedures that in this day and age would be considered hypnotic. (The word ‘hypnosis’ was only invented in the 1800s.) Interest in its use has fluctuated throughout the years and is currently in resurgence perhaps due to the ever expanding scientific literature detailing its efficacy, combined with the general public’s search for a viable alternative/accompaniment to so called conventional medicine.

Hypnosis is, in essence, a very pleasant and natural state of deep mental and physical relaxation that is often referred to as trance into which almost anyone can enter if they so wish. In this state a person is open to accepting beneficial suggestions delivered by a therapist (a process known as hypnotherapy) that can help alleviate a wide range of presenting symptoms.

However, for some the very word hypnosis is steeped in mysticism and many erroneous myths have arisen surrounding the subject. For example, the belief that it is akin to brain washing is far from the truth, and it is important to realise that hypnosis is not mind control. A patient in trance is not ‘under the power’ of the therapist. On the contrary, full control is maintained throughout with the unconscious mind protecting the subject, rejecting unwanted suggestions or any that are alien to a person’s ethical or moral beliefs. Essentially, hypnotherapy is a therapeutic method that allows a person to regain control over an area of their life where they feel control has been lost, thus helping to alleviate both psychological and physical symptoms. 

By Peter Mabbutt

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Thousands are Dodging the Dentist

Hard-up people are putting their health at risk by avoiding trips to the dentist, a new survey shows.

Sixty eight per cent of dentists said their patients were deferring treatment and 59 per cent reported cancelled appointments.

The poll of 251 dentists in England, for the British Dental Association (BDA), found the knock-on effect was a clear rise in the numbers needing emergency treatment.

More than a third (34 per cent) of practitioners questioned in October and November said they had seen increased demand for emergency treatment over the previous 12 months.

Dental check-ups often reveal more serious underlying health problems than simple gum disease.

Some dental diseases are closely linked to many serious health conditions including heart disease, arthritis and diabetes.

‘It’s understandable that, at a time when there is widespread concern about household finances, some patients’ financial anxieties are leading them to defer dental appointments and treatment,’ said Susie Sanderson, of the BDA.

‘Achieving short-term money savings at the expense of longer-term health problems isn’t wise, though.

‘Neglecting your oral health can increase both the complexity of the problems you face and the cost of the treatment you must eventually have.’

Click here to read more.

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Hypnosis and Surgery

From a talk given to the James Braid Society in July 2002:

Hypnosis and Pre and Postoperative Surgery

Peter Mabbutt FBSCH

CEO/Director of Studies

Despite the fact that we live in a health-conscious society cardiovascular disease is still one of the major causes of premature death.

These days we drink too much; we eat too much (of both the wrong and right kinds of food); and smoking is still endemic. Compounding this we are encouraged to lead increasingly sedentary and stressful lifestyles. All this represents bad news for the heart as these activities place it under increasing strain and could result in the development of cardiovascular disease.

If recognised early enough, drugs and a change of lifestyle are all that’s needed to provide an effective route to management and recovery from cardiovascular disease. However, for some the only route to better health will be through surgical intervention.

For anyone facing the prospect of surgical intervention this will be a major event in their life. Despite the fact that the techniques of cardiovascular surgery have advanced immeasurably over recent years, as with all surgical interventions there is a risk of death. It is therefore not surprising that patients faced with surgical intervention go through a whole range of feelings and emotional responses. Research has shown that 60% of patients hospitalised for heart disease experience elevated levels of stress, anxiety and depression. Unfortunately the heart responds unfavourably to these emotional states thus placing extra demands on an already damaged cardiovascular system.

Psychology of surgery

For anyone being told that they need to undergo a surgical procedure this will undoubtedly provoke a stressful response, that may increase when the surgery is considered to be major or life saving. For many this can bring on a bereavement reaction as they will experience a whole range of losses: a loss of health; a perceived loss of control over their life; and a possible loss of independence. Also, they are likely to experience guilt over the harm their life-style may have caused their body. Compounding this may be an increased awareness of their own mortality as they are going into hospital for an operation that will save their life. Fear is another factor that features as many patients may be worried that they will not survive the surgery or, alternatively, that they may be damaged mentally or physically in some way by the surgical procedure.

It must be remembered that psychological disturbance also occurs during the post-surgical period. Even when surgery has been successful many patients will enter a period of post-surgical depression. Many factors may be responsible including a continued perception of lost health due to post-anaesthetic nausea, pain, and worry about the healing process. Patients may also experience a profound loss of control over their life. During the early stages of recovery they may be bed-bound and therefore reliant on others for cleaning, feeding and drinking. Compounding this they will experience a loss of privacy with regard to bodily functions, as urine and faecal output need to be monitored immediately after surgery.

Many patients will experience concerns over what they will and won’t be able to do in the future as a result of their heart condition and surgery. Unfounded concerns that they will be unable to engage in the sexual act can lead to psychogenic sexual dysfunction. The belief that they may damage the heart during coitus can lead to performance anxiety with all its consequences.

Often patients will exhibit concerns that they will be unable to give up activities proscribed by their medical-care team such as excessive alcohol consumption, smoking and eating certain foods.

If left untreated all these psychological factors could provoke a negative mind-set. Many studies have shown that a patient’s outlook toward upcoming surgery as well as to the post-surgical period can greatly affect recovery outcome. Essentially, patients with a poor outlook may have a poor prognosis (it has also been shown that those patients who are socially isolated and come from the lower-income bracket are also at greater risk post-surgically). However, those patients showing an optimistic outlook recover more rapidly and show an increased survival rate.

Studies have shown that those patients undergoing hypnosis as an integral part of the pre- and post-operative procedure demonstrate an increased rate of recovery and decreased levels of post-surgical infection.

Hypnosis and Surgery

As the patient should be set up for success from the beginning, pseudo orientation in time needs to be included on each session, taking the patient to a time in the future when they have successfully recovered from the operation. It goes without saying that the therapist must ensure that the pseudo-orientated future is realistic and achievable. As well as this, ego boosting should also be included on each session to help the patient create a positive mind-set and to enhance inner resources.

Reframing approaches should not be ignored. It is an undeniable fact that the patient’s life-style may have led to the reason they are in hospital at this time. Reframing the situation so that the patient perceives that they are taking control of their future thus ensuring a speedy recovery as well as living a long, healthy and productive life will be of obvious benefit to the therapeutic process.

Induction of Hypnosis

A word needs to be said about the induction process used with cardiovascular patients. Any induction will suffice. However, as part of the therapeutic process it is important to teach the patient how to relax, so progressive relaxation approaches should be the therapist’s primary consideration as this will indirectly provide a format for the patient’s own approach to relaxation.

Dealing with Fear

Many patients will understandably have a fear of the process of surgery and of their stay in hospital. Imagination techniques (a preferable term to visualisation as asking someone to visualise implies that they have to ‘see’ and therefore does not take into account the other modalities of representation) should be used to take them through their hospital experience and beyond: being admitted to hospital; the pre-surgical stay; going to the operating theatre and receiving their pre-medication; undergoing the operation; their time in the recovery room; being taken back to the ward and their post-operative stay; leaving hospital; and making a full recovery. Presented scenarios should show the patient coping calmly, confidently and with appropriate self-control. Again the therapist needs to be realistic with regard to the outcome. Self-hypnosis should be taught and the patient encouraged to practice these imagination techniques.

If the patient has specific fears with regard to their stay in hospital, for example needle phobia, these need to be dealt with as a separate issue.

Life-style Issues

Many patients presenting for cardiovascular surgery will be advised to make life-style changes. These may include reducing their alcohol intake, stopping smoking or reducing their weight. Here hypnosis takes an obvious role and standard approaches are used. For the patient there is the added incentive of the increased health risk should they not change which will provide a strong motivator that can be used during therapy. Care should be taken as some may view these life-style changes as a short-term adaptation and may subsequently revert to old behaviours once they have recovered (a possible indication that they are experiencing denial with regard to the seriousness of their heart condition).

Stress management should be taught, as stress responses will place an added burden on an already damaged heart. The use of self-hypnosis should be included and encouraged, as the trance state will reduce any stress-induced increase in cardiac activity. It is also known that the trance state will reduce blood pressure (high blood pressure, or hypertension, is a major risk-factor in coronary disease).

Post-surgery

In many cases pre-surgical hypnotic intervention will help to prevent post-surgical depression. However, biochemical changes occurring after the use of anaesthetics may result in the patient developing an endogenous depression. This state should be dealt with appropriately.

A positive mental attitude towards the healing process needs to be encouraged. Various approaches can be taken with an emphasis placed on healing the body: asking the patient to imagine the heart healing and becoming more healthy; imagining the wound healing, the tissue and bone knitting together with the minimum of scarification; imagining the body protecting the wound, the immune system guarding the incision and preventing infection.

Pain may be an issue and the full range of pain control techniques should be employed: glove anaesthesia; imagination approaches; control room of the mind; dissociation.

The therapist should also help the patient to maintain recommended life-style changes.

Cardiophobia

Some patients develop cardiophobia: an abnormal awareness of their heart beating. This can provide a focus for neuroticism after any heart event or surgical intervention, as the patient may believe that naturally occurring changes in the beating of the heart herald a catastrophic heart event. Consequently they become over-protective towards their cardiovascular system and this may lead to a sedentary life-style (that in its own right will be damaging to the heart). Desensitisation approaches and reframing should be used.

Regression

A word of warning with regard to the use of regression with patients who have experienced a heart event needs to be given. Do not take them back to the event as they may re-experience it with inevitable consequences. If carrying out a diagnostic approach, regressing the patient year by year, avoid the year in which the event occurred for same reason. If possible regression should be avoided.

Conclusion

Hypnosis can play an important role in cardiovascular surgery by helping to create a positive mental outlook for the surgical patient. This, combined with helping the patient undertake and maintain lifestyle recommendations, can significantly increase the prospects of a full and healthy recovery.

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