2. The Role of Mind, Body, and Spirit in Treating Chronic Illness and Disability: Foundations of Breathing, Meditation, and Visualization Mark A. Stebnicki, Ph.D, LPC, CRC, CCM Professor- Dept. of Addictions & Rehabilitation East Carolina University www.ecu.edu/rehbwww.ecu.edu/rehb www.thpartnership.com www.thpartnership.com www.ecu.edu/rehbwww.thpartnership.com

3. Impact Stress & Emotions Have on Illness

4. Neuroscience, the Emotional Brain, & Whole Body Connection There are discrete, basic, and universal emotions that persons react to on a M-B-S level; There are discrete, basic, and universal emotions that persons react to on a M-B-S level; Emotions involve different body systems which arouse our parasympathetic and sympathetic system; Emotions involve different body systems which arouse our parasympathetic and sympathetic system; Chronic activation of the nervous system (stress response) has both a physiological and emotional cost; Chronic activation of the nervous system (stress response) has both a physiological and emotional cost; 80% of all physical illness is cause by 80% of all physical illness is cause by Stress (Kabit-Zinn, 1990; Sapolsky, 1998; Selye, 1976; Weil, 1995)

5. It all Begins with Sympathetic- Parasympathetic Nervous System

6. The Emotional Pathways of the Brain: The Ladder of Perception * The human brain is cable of six senses (see, smell, taste, touch, hear, and balance) which contains stored perceptions that have formed specific neural patterns since birth. * Our brains are limited to perceive light of specific wavelengths, sounds of specific frequencies, and smells, tastes, tactile experiences that are limited and unique to our individual experiences – since birth. * Pre-determined chemical and electrical impulses {Amygdale} are triggered when we perceive certain emotions {fear, stress, love, anxiety}. *Amygdala {our home security system} and hippocampus responsible for reading, interpreting, making sense of our own emotions and others- sends out a total body emergency call (our sympathetic nervous system)

7. What is Mind-Body-Spirit? Mind: consciousness, perceptions, philosophies, beliefs, thoughts, attitudes, feelings, and cognitions. Body: physiological, cellular, and biological functioning of all body systems. Spirit: (different from religiosity) that which cannot be seen, made-up of experiences of faith, hope, comfort, beliefs, philosophies, rituals, belief in a divine source of energy that guide our lives.

8. Research on Spiritual Well-being Significant reduction in B/P Significant reduction in B/P Stronger immune system response Stronger immune system response Fewer overall health problems Fewer overall health problems Stronger interpersonal and social connections Stronger interpersonal and social connections Lower rates of depression, anxiety, and stress-related conditions. Lower rates of depression, anxiety, and stress-related conditions.

9. THE Most Important Questions: Ask a Partner 1. Where did we come from and where are we going after we leave planet Earth? 2. Is there a grand design or unified theory at the quantum level that remains unchanging, static, or fixed? 3. Do all things happen for a reason- or can we control and change things? 4. Why do bad things happen to good people? 5. Is there a God (Great Spirit, Higher Power)?

10. Hindu Parable of The Monkey and the Cocoanut

11. Show-up Pay Attention Be Open to the Outcomes

12. A Paradigm Shift in Conventional Medicine - MH Health Healing Practices A Brief History of Everything in Western Consciousness Studies (or IM): 1960s: Human Potential and Personal Growth Movements began in Big Sur CA- Eslen- strategies for empowerment, creative problem solving, happiness, self-actualizing. 1960s: Human Potential and Personal Growth Movements began in Big Sur CA- Eslen- strategies for empowerment, creative problem solving, happiness, self-actualizing. 1970s: Birth of New Age movement & the Self-help book. 1970s: Birth of New Age movement & the Self-help book. New Age movement both Western paradigm cognitive- behavioral and humanistic based, and Eastern philosophies Goal of achieving M-B wellness- but criticized as a pseudoscience, overuse of psychobabble- too New Agey. New Age movement both Western paradigm cognitive- behavioral and humanistic based, and Eastern philosophies Goal of achieving M-B wellness- but criticized as a pseudoscience, overuse of psychobabble- too New Agey. Late 1970s significant growth in transpersonal psychology- the esoteric, developing psychic-intuitive abilities, secular mysticism, Native American traditions. Late 1970s significant growth in transpersonal psychology- the esoteric, developing psychic-intuitive abilities, secular mysticism, Native American traditions.

13. Early Stress Research: Stress is a lot Like Gravity { Hans Selye’s 1950s General Adaptation Syndrome} “An overwhelming type of stress (e.g., excessive worry, extreme emotional-physical fatigue, trauma) can break down the body’s protective mechanism. If a microbe is in our body or around in our external environment all the time and yet causes no disease until we are exposed to stress, then what is the cause of our illness- the microbe or stress? Both are equal. In most instances, disease is due neither to the germ as such, nor our adaptive reactions, but to the inadequacy of our reactions against the germ”.

14. Psychoneuroimmunolgy (PNI) Multidisciplinary approach (1970s) (combines psychology, neurology, immunology, biology) for discovering how our M-B-S are interconnected. Multidisciplinary approach (1970s) (combines psychology, neurology, immunology, biology) for discovering how our M-B-S are interconnected. PNIers have a difficult task-of associating our M-B-S with chronic illness, disease & disability because each person has their own unique pattern of physiological arousal to stress, perceptions, and emotions which creates its own magnitude, frequency, and intensity. PNIers have a difficult task-of associating our M-B-S with chronic illness, disease & disability because each person has their own unique pattern of physiological arousal to stress, perceptions, and emotions which creates its own magnitude, frequency, and intensity.

15. 21 st Century Integral Medicine: M-B-S IM includes diagnosing, treating, and preventing CID- using non-traditional methods to determine its effectiveness rather than true experimental design and rationale models of thinking; IM includes diagnosing, treating, and preventing CID- using non-traditional methods to determine its effectiveness rather than true experimental design and rationale models of thinking; IM includes qualitative designs using subjective means of diagnosing and treating CID; IM includes qualitative designs using subjective means of diagnosing and treating CID; IM uses the person’s experience of what IM uses the person’s experience of what they perceive to be helpful in terms of they perceive to be helpful in terms of prevention, healing, and cure.

16. Role of M-B-S: Personal Testimonials

17. “The tragedy of life is not death; but what dies inside of us as we live” -Norman Cousins Anatomy of an Illness was the first book by a patient that spoke to our current interest in taking charge of our own health. It started the revolution in patients working with their doctors and using humor to boost their bodies' capacity for healing. When Norman Cousins was diagnosed with a crippling and irreversible disease, he forged an unusual collaboration with his physician, and together they were able to beat the odds. The doctor's genius was in helping his patient to use his own powers: laughter, courage, and tenacity. The patient's talent was in mobilizing his body's own natural resources, proving what an effective healing tool the mind can be. This remarkable story of the triumph of the human spirit is truly inspirational reading.

18. Depressing News Poorly treated, recurrent, chronic and persistent depression results in neurodegenerative changes in the hippocampus and prefrontal cortex. Poorly treated, recurrent, chronic and persistent depression results in neurodegenerative changes in the hippocampus and prefrontal cortex. Major depressants under high levels of stress in longitudinal studies show rapid brain cell death and atrophy resulting in treatment- resistant drug therapies. Major depressants under high levels of stress in longitudinal studies show rapid brain cell death and atrophy resulting in treatment- resistant drug therapies.

19. Juggling

20. Why Zebras Don’t Get Ulcers Dr. Sapolsky

21. The Perception of Stress * Some emotions trigger a “fight-flight” response which increases blood flow to muscles, activates our cardiovascular system, and secretes stress hormones-epinephrine and norephinephrine heightens reactivity to stress. * End result – hypothalamus region of the brain, acting through the pituitary gland stimulates the neuro stress hormone Cortisol, which depresses overall brain functioning, can be toxic to tissue at high levels, depresses memory, learning, and are markers for depression and anxiety.

22. Zebras Cortisol Adrenaline Pituitary Hypothalamus

23. So Why Don’t We All Die from Stress? We all differ as to the: We all differ as to the:-pattern - frequency -exposure-magnitude/intensity -immune competence & resistance …..of how we turn-on our own stress response

24. Q. Why Zebras Don’t Get Ulcers Answer: Zebras don’t have cumulative stress “If you constantly mobilize energy, You never store it; Your muscles waste away; Your vascular system is under constant pressure; and constant Cortisol production turns off growth factors and can harm every system in the body…”

25. Stress and Disease: Result of Too Many Unhealthy Thoughts, Perceptions & Feelings Excessive, recurrent, and intense emotional arousal of an unhealthy nature results in stress and disease; Excessive, recurrent, and intense emotional arousal of an unhealthy nature results in stress and disease; Repeated reactivation of our perceptual-cognitive- affective response that is unhealthy in nature…; Repeated reactivation of our perceptual-cognitive- affective response that is unhealthy in nature…; Stored unhealthy thoughts, perceptions, and emotions, become a worn neural pathway which leaves an imprint on our cognitive unconscious and causes a mind-body interaction. Stored unhealthy thoughts, perceptions, and emotions, become a worn neural pathway which leaves an imprint on our cognitive unconscious and causes a mind-body interaction.

26. Is the Etiology of Depression- STRESS? Incidence and Prevalence THE most common medical and psychiatric condition seen in primary care clinics; 30% of patient caseloads have depression; by 2020 depression will be the second major cause of disability in the U.S. THE most common medical and psychiatric condition seen in primary care clinics; 30% of patient caseloads have depression; by 2020 depression will be the second major cause of disability in the U.S. Multiple factors account for etiology of depression but at least half remain undiagnosed/untreated because patients deny any of the emotional-psychological symptoms. Multiple factors account for etiology of depression but at least half remain undiagnosed/untreated because patients deny any of the emotional-psychological symptoms. 69-80% of patients with depression present exclusively with physical symptoms; Thus, most physicians treat only the physiological symptoms of depression. 69-80% of patients with depression present exclusively with physical symptoms; Thus, most physicians treat only the physiological symptoms of depression. As a result of the biomedical model of treatment in primary care settings -the focus is on medication (not psychotherapy). As a result of the biomedical model of treatment in primary care settings -the focus is on medication (not psychotherapy).

27. Prevalence & Incidence 65% of patients with chronic muscular skeletal pain are depressed. 65% of patients with chronic muscular skeletal pain are depressed. 60% rate of depression among some types of cancer patients. 60% rate of depression among some types of cancer patients. Depression is a natural artifact of CID conditions- acct for 15-30%. Highest rates of depression include: Depression is a natural artifact of CID conditions- acct for 15-30%. Highest rates of depression include: Neurological conditions: M.S., Parkinson’s, Stroke, BI Endocrine disorders: Hypothyroidism, Cushings syndrome Autoimmune disorders: R.A. Systemic Lupus Mood disorders affect women 2-3xs more than men and is the #2 cause of disability among females. Mood disorders affect women 2-3xs more than men and is the #2 cause of disability among females. In the general population 15-20% of people are treated for depression with 80% recovery- 22% relapse within first year of recovery. When CID is attributed to depression- cond. more chronic In the general population 15-20% of people are treated for depression with 80% recovery- 22% relapse within first year of recovery. When CID is attributed to depression- cond. more chronic

28. Evidence for Spontaneous Healing from M-B-S Level Human body is in a constant state of equilibrium- it requires a high degree of coherence and organization to produce 600 billion cells every 24 hrs (or 10 million cells per second). Every 90 sec. millions of antibodies are synthesized from about 1200 amino acids (200/hr). No matter how diverse cells and organs are- they co-exist in the same body maintaining harmony, balance, and an interconnected vibrational energy.

29. Your Body Can Heal Itself- It Wants to be Healthy A natural healing system is in place at the very biological-physiological level (DNA, Cell structures, immune functioning) A natural healing system is in place at the very biological-physiological level (DNA, Cell structures, immune functioning) Our DNA IS our natural repair system because it goes through the complex chemical process of replication-transcription-translation. Our DNA IS our natural repair system because it goes through the complex chemical process of replication-transcription-translation.

30. Immune System: Innate & Adaptive Primary job : -Defend against infectious viruses, free radicals, bacteria, fungi, parasites-communicate with Lymphatic system Lymph System - contains lymph nodes (glands) that stores WBC and B & T Lymphocytes to help fight infection Innate : first line of defense-skin, tears, mucous membrane, gastric secretion Adaptive (Acquired) or Inflammatory Response : Phagocytes or micro/macrophages sent to destroy/ingest bacteria, dead tissue, & foreign material

31. Process of Immune System Immune system acts as the “inspector” of all tissue cells and organ cells & microorganisms that it comes in contact with works 7-24-365. Immune system acts as the “inspector” of all tissue cells and organ cells & microorganisms that it comes in contact with works 7-24-365. Immune system IDs the distinctive cellular signature of tissue and records it in the DNA structure (memorizes) all cells to determine which are normal and which are invaders. Immune system IDs the distinctive cellular signature of tissue and records it in the DNA structure (memorizes) all cells to determine which are normal and which are invaders. Immune system has immunologic memory to help with the fight so it can better prepare itself for future invasions a.k.a. acquired immunity- part of Adaptive Immune system. Immune system has immunologic memory to help with the fight so it can better prepare itself for future invasions a.k.a. acquired immunity- part of Adaptive Immune system.

32. Impaired Defenses Stress Research Persistent and overwhelming infections or a physiological assault on our immune system. Persistent and overwhelming infections or a physiological assault on our immune system. Toxins in our body: Toxins in our body: - water we drink - air we breathe - food we eat - pharmaceutical products we take - thoughts, feelings, cognitions we have

33. Victor Frankel “…it’s not necessarily the nature of the stressful or traumatic event itself that most affects our ability to cope with adversity and its consequences, rather, it’s our own attitude and perception towards the event itself…”

34. Zen Master Could Be Good- Could Be Bad

35. Stress-Resiliency Quiz 1= not true of me….5=exceptionally true of me As a person I perceive myself to be… 1. Resilient, adapt quickly to new situations as they arise, and good at bouncing back after listening, attending, and responding empathically to others. 2. Optimistic, perceive that I can increase my level of adaptive functioning regardless of how difficult my issues are, and I anticipate that things will turn out well for me. 3. Calm and focused while my life is in crisis. 4. A good problem-solver by empowering myself with good resources. 5. Able to trust my own intuition and develop creative solutions to stressful life-challenges.

36. Resiliency Quiz (continued) 6.Self-confident, optimistic, enjoy healthy self-esteem, and have an attitude of professionalism about my work. 7. Playful, humorous, have the ability to laugh at myself. 8. Curious and have a desire to understand how things work in my own life, and talk with others when I need help. 9. Constantly learning from my past mistakes and from the mistakes that I see others make. 10. Flexible and feel comfortable with things that are somewhat complex in my life, and can adapt to various behaviors and personalities around me.

37. Resiliency Quiz (continued) 11. Able to anticipate specific problems and I have confidence that I will know how to deal with the unexpected. 12. Able to personally deal with my negative or dysfunction life patterns and the ambiguity or challenge this presents in my life. 13. Non-judgmental, a good listener, possess good empathy, express my feelings and be able to “read” other people well. 14. Able to recover emotionally from losses and setbacks, and let-go of negative feelings that I may have and how to ask others for help.

38. Resiliency Quiz (continued) 15. Durable, keep on ticking after tough situations and possess a balanced and healthy fighting spirit. 16. Stronger and better after tough situations and difficult times. 17. Able to discover some meaning in my own life at the end of the day, even after experiencing daily stressors.

39. Resiliency Quiz Scoring 75 + = Very Resilient!! 65-75 = Resilient more than most. 55-65 = Slow to rebound- but adequate. 45-55 = Whoa- I’m struggling as a person. 45 or less = I should leave now and seek help!

40. The Resiliency Advantage Dr. Al Siebert 1. Making conscious choices in life. 2. Power of Positive Thinking. 3. Take responsibility. 4. Internal locus of control. 5. Self motivate yourself. 6. Don’t fear trying-out new things. 7. Take control of your life. 8. Practice positive approaches to life.

41. Psychosocial Adjustment to CID Stage Model Adjustment/Adaptation Acknowledgment Externalized Hostility Internalized AngerDepression Denial Anxiety

42. Chronic Illness and Disability (CID): A Loss, Grief, & Stress Response Control Over Ones’ Life - Independence Loss of Faith in God – Ones’ Spirituality Loss in a Sense of Fairness or Justice Loss of Emotional Security- Mental Capacity Loss of Physical Abilities- Body Image- Sexuality Loss of Career-Vocational Capacity

43. Course of CID depends upon: Stability Stability Progressive nature Progressive nature Episodic nature Episodic nature Degenerative nature Degenerative nature Periods of Exacerbation Periods of Exacerbation and Remission and Remission

44. Defense Mechanisms in Coping Denial (Healthy vs Unhealthy) Emotional insulation WithdrawalCompensationRepression-suppressionIntellectualizationRationalizationProjection

45. Common Issues in Response to Disability and Adjustment: A Developmental Perspective Across the Life-Span Unhealthy coping Self-concept Self-esteem Body Image Stigma Dealing with Invisible vs Visible Disability Sexuality Quality of Life

46. Operation Enduring Freedom (AFG, 2001) Operation Iraqi Freedom (Iraq, 2003) Operation New Dawn 2010 6,000 + U.S. fatalities 6,000 + U.S. fatalities Over 162,000 Iraqi combatants and civilian deaths Over 162,000 Iraqi combatants and civilian deaths 43,000 + wounded 43,000 + wounded - Amputations - TBI - SCI - Burns - Muscular Skeletal injuries

47. Unique Differences in Exposure: Combat vs. Non-combat Mortar Mortar Rocket Rocket Artillery Fire Artillery Fire Small Arms Fire Small Arms Fire Multiple High-Intensity blast Multiple High-Intensity blast Roadside bombs Roadside bombs IEDs IEDs Sniper Attack Sniper Attack

48. Unique Psychosocial Characteristics for Active Duty, Vets, Disabled Vets Family members At least 19% of active duty men/women returning from Iraq will develop PTSD. At least 19% of active duty men/women returning from Iraq will develop PTSD. Strong “r” between being shot at, handling dead bodies, knowing someone who was killed, or killing the enemy and developing PTSD. Strong “r” between being shot at, handling dead bodies, knowing someone who was killed, or killing the enemy and developing PTSD. Only 38%-45% report receiving help for mental health services within a year. Only 38%-45% report receiving help for mental health services within a year. Women comprise 14% of deployed forces, more than ever before Women comprise 14% of deployed forces, more than ever before

49. More Problems 26-39% met positive screen for PTSD (gen. pop= 12%). 26-39% met positive screen for PTSD (gen. pop= 12%). 25% come home with a medical health problem. 25% come home with a medical health problem. Approx. 1700 service men/women returning report thoughts of hurting themselves; nearly 20,000 reported nightmares or flashbacks of war memories Approx. 1700 service men/women returning report thoughts of hurting themselves; nearly 20,000 reported nightmares or flashbacks of war memories 32% + screen for depression; 25% + alcohol abuse; 33% met criteria for addiction. 32% + screen for depression; 25% + alcohol abuse; 33% met criteria for addiction. Co-morbid physical injury (TBI, SCI, Amputation) at least doubles the risk for mental health conditions. Co-morbid physical injury (TBI, SCI, Amputation) at least doubles the risk for mental health conditions.

50. Psychosocial Characteristics of Combat Vets in Physical Rehab Multiple muscular-skeletal injuries of upper and lower limbs require long periods of rehabilitation creating more mental health problems. Multiple muscular-skeletal injuries of upper and lower limbs require long periods of rehabilitation creating more mental health problems. Because many soldiers pre-injury were in excellent physical shape- many want to return to a very active lifestyle. Because many soldiers pre-injury were in excellent physical shape- many want to return to a very active lifestyle. Heavy reliance on medical and Heavy reliance on medical and assistive technology assistive technology

51. Psychosocial Characteristics Multiple reconstructive surgeries require not just one adjustment to disability- rather there are multiple re-adjustments. High incidence of chronic pain conditions. Functional limitations- residual functional capacity forces solider in civilian life prematurely resulting in significant vocational impairments.

52. Holistic Treatment and Transition Services: From Solider to Civilian Dx: and treatment of mental health disorders. Dx: and treatment of mental health disorders. Psychosocial counseling. Psychosocial counseling. Family and/or relationship counseling. Family and/or relationship counseling. Vocational evaluation, career, Ed. assessment. Vocational evaluation, career, Ed. assessment. Medical and healthcare services. Medical and healthcare services. Medical supply and assistive technology. Medical supply and assistive technology. Allied health services. Allied health services.

53. Family Issues: A Parallel Experience Primary caregiver neglects own mental-physical- spiritual wellness Family misinterpret behaviors and resents the caregiver role Family experiences Loss & grief response Family structure and roles are significantly altered and disrupted

54. Chronic Pain Syndrome Insurance Company Disability System of Benefits Psychiatrist Psychologist Medical Community Employer Family Members

55. Contemplative Meditation: It’s just a shell game Show-up Pay Attention Be Open to the Outcomes

56. Show-up Be Present How am I emotionally cognitively, physically, spiritually aware of my verable? Is there anything I motivated to change in my life at this moment? What capacity do I have for genuineness, positive regard, empathy, and compassion for self & others at this moment?

57. Pay Attention Be Mindful Requires a shift of consciousness becoming Requires a shift of consciousness becoming mindful of what your mind-body-spirit needs. Paying attention to the present moment- that’s all you need for the “now moment.” Paying attention to the present moment- that’s all you need for the “now moment.” Listening non-judgmentally for understanding your inner voice experience with your verable. Listening non-judgmentally for understanding your inner voice experience with your verable. Cultivating a state of openness nurturing the soul. Cultivating a state of openness nurturing the soul. Achieve greater awareness and clarity regarding shape, color, feel, sound, thoughts, your intention for communicating with your verable. Achieve greater awareness and clarity regarding shape, color, feel, sound, thoughts, your intention for communicating with your verable.

58. Be Open to the Outcomes and Experiences Being realistic of the obstacles and challenges you have meditating with your verable. Being realistic of the obstacles and challenges you have meditating with your verable. Brainstorm, be creative, cultivate a vision for your experiences. Brainstorm, be creative, cultivate a vision for your experiences. Be open to spontaneous belief that you may have gained something from this experience. Be open to spontaneous belief that you may have gained something from this experience.

59. Evaluative Questions 1. What are the things/issues in the person’s life do you recognize needs changing to get this person back to balance from a Mind-Body-Spirit level? 2. Does the person recognize the need for changing their patterns of thinking, acting, feeling? 3. How ready or motivated is this person for change? 4. What would this person look like or be doing differently if they were to change? 4. What are some resources they (or you) have to assist this individual in their career-vocational, social, emotional, mental, relational, or family wellness?

60. The Price of Pain Pain IS the #1 cause of disability in the U.S. All things considered: $120 billion per yr. 50 million people are either partially or completely disabled by pain conditions. Low back, headache, and arthritic pain most commonly reported type of pain. Pain is a subjective experience.

61. How Subjective ???

62. More Pain…Assessments

63. Subjective Assessment of Pain What is the location of your pain? What is the location of your pain? How frequently do you experience the pain? How frequently do you experience the pain? Describe you pain (dull ache, sharp, burning, throbbing, blunt) Describe you pain (dull ache, sharp, burning, throbbing, blunt) How long does the pain last? How long does the pain last? How intense is the pain: 1-10 scale with 1= no pain and 10= need to go to ED How intense is the pain: 1-10 scale with 1= no pain and 10= need to go to ED What activities tend to cause the onset of pain? What activities tend to cause the onset of pain? What other things aggravates your pain? What other things aggravates your pain?

64. Subjective Intake of Pain continued What do you do to alleviate the pain? What do you do to alleviate the pain? What kinds of activities are you able to perform when your pain is present? What kinds of activities are you able to perform when your pain is present? What activities do you avoid? What activities do you avoid? How has your pain changed what you do at (work, home, school, hobbies, social, emotion) How has your pain changed what you do at (work, home, school, hobbies, social, emotion) How does your pain affect your relationships with others (family, friends, partner…) How does your pain affect your relationships with others (family, friends, partner…) Are you involved in any litigation related to your pain? Are you involved in any litigation related to your pain?

65. Journaling Experiences * Spontaneous writing (dreams, fantasies) * Open and honest * Accept whatever comes to mind * Grammar- spelling fagetta-bout-it * Process is just for You

66. Native American Teaching “Every time you heal someone, you give a piece of yourself away, until at one point you will need healing yourself” * Shaman or Medicine Man/Woman in many indigenous cultures understood that in healing practices the healer sometimes must takes-on the pain and suffering of others while planting the seeds for transformation. * Each personal transformation should bring about the necessary experiences for handling the next crisis so the mind, body, and spirit can be transformed.

67. Empathy Fatigue (EF) “ A dynamic state of physical, psychological, emotional, social, occupational, and spiritual exhaustion that occurs on a continuum, resulting from the helpers’ own wounds that are continually revisited by their client’s life- stories of chronic illness, mental/physical disability, trauma, grief, and loss.”

68. The Experience of Empathy Fatigue: Feeling ….. Physically exhausted Physically exhausted Emotionally drained Emotionally drained Persistent negativity Persistent negativity Alone and disconnected Alone and disconnected Not effective at work Not effective at work Organizational dysfunction Organizational dysfunction Personality characteristics Personality characteristics Unhealthy coping Unhealthy coping

69. Summative Philosophy of EF It is not necessarily the nature of the client’s stress, trauma, loss, grief, daily hassles, coping, or disability adjustment that creates a sense of EF for the professional; rather it is the professional’s perception towards that particular client and the helper’s personality traits, states, and behavior that determines the response; which is determined by multiple factors that lead to a diminished capacity to listen, respond empathically, provide competent professional services…

70. Changing the Stress Response: Protective Factors & Resiliency Feeling some degree of internal control; Feeling some degree of internal control; Exerting some control over your environment; Exerting some control over your environment; Increasing your level of information and awareness; Increasing your level of information and awareness; Changing your thoughts and perceptions; Changing your thoughts and perceptions; Shifting from mindless (unconscious) reaction to mindful recognition; Shifting from mindless (unconscious) reaction to mindful recognition; Creative solution-focused problem-solving; Creative solution-focused problem-solving; Support from others in our socio-familial environment; Support from others in our socio-familial environment; High-ranking Baboon; Not living alone !! High-ranking Baboon; Not living alone !!