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Ben also felt increased motivation to do his work, and stopped avoiding study time. Setting up a schedule for yourself in September or January can be enormously helpful in keeping your academic stress and overwhelm at more manageable levels throughout the term. Good Self Care involves attending to our social, physical, emotional, mental, and spiritual needs. We need to make room to meet these deep needs in our lives or we will not have the energy or resources to meet the significant demands placed upon us. When we are depleted in one or more of these areas we will be more vulnerable to overwhelm and, subsequently, burnout. It is crucial to keep our bodies, minds, and selves energized, vibrant and healthy. It means ensuring that we are getting approximately 8 hours of sleep a night, eating regular healthy snacks and meals throughout the day, engaging in moderate exercise, making time to spend with supportive friends or family, and finding ways to nourish ourselves emotionally. You need to make time to do nothing at regular intervals in order to keep stress levels down by giving your body and mind a chance to recover from stress. Finally, doing nothing affords us the opportunity to follow our bliss or to do something just because we feel like it; a luxury in our highly structured lives where there is so much that we have to get done every day. When we have a lot that we need to do, or are in a state of stress or overwhelm, our tendency is to neglect our basic needs in order to get the things done that we need to get done. This is a crucial mistake: the more demands placed upon us, the more we need to be engaging in good Self Care. Remember, too, that caring for yourself will boost your productivity and your ability to perform academically, as our brains work better when our bodies and selves are well cared for. Ana realized that she had almost no time available for Self Care, personal time, or time to do nothing. Ben made the commitment to resume and maintain his workouts three times per week throughout the term. Remember to block all of your Self Care activities into your Weekly Schedule (including doing nothing! On the lines below write down two Self Care priorities that you could either introduce or be more consistent with that could help reduce anxiety and prevent overwhelm: Two Self Care strategies I would like to prioritize include 1. Now, book all four of these items into your weekly schedule for the remainder of the term. Over the course of the term, notice how practicing regular Self Care helps your anxiety/stress, physical well-being, emotions, and productivity level. Practice Other Basic Anxiety Management Skills: the same techniques we teach people for anxiety are very effective at warding off the effects of everyday stress and overwhelm.

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Overall there is fairly consistent evidence that individuals who experience recurrent panic attacks report greater sensitivity to physical sensations and are more likely to interpret these symptoms negatively (see also Taylor, Koch, & McNally, 1992). A consistent fnding across these experimental studies is that panic disorder patients evidence a signifcantly greater subjective response to the sensations produced by the inductions as indicated by higher ratings on the intensity, severity, and anxiousness associated with the bodily sensations produced by the induction manipulations. Beck, Ohtake, & Shipherd, 1999; Holt & Andrews, 1989; Rapee, 1986; Schmidt, Forsyth, Santiago, & Trakowski, 2002; Zvolensky et al. If panic disorder is characterized by increased vigilance for physical sensations, we might expect panic disorder patients to demonstrate greater acuity or perception of their physiological responding. Moreover, heart rate acceleration occurred after cardiac perceptions that were associated with intense anxiety whereas cardiac perceptions associated with no anxiety led to heart rate deceleration. Early fndings suggested that individuals with panic disorder had better heartbeat perception than other patient groups or nonclinical controls. Moreover, only a minority of the panic disorder patients was classifed as accurate perceivers (17%). Thus accurate heartbeat perception appears to be a characteristic of having frequent episodes of clinical anxiety as opposed to panic attacks per se. An automatic, preconscious attentional processing bias for physical cue words should be apparent if panic is characterized by hypervigilance for bodily sensations. Lundh and colleagues (1999) found that panic disorder patients had signifcantly higher Stroop interference effects to panic-related words than nonclinical controls at both a subliminal and a supraliminal level but this biasing effect was also evident for interpersonal threat words. In addition the panic disorder group identifed more panic-related words presented at perceptual threshold (see also Pauli et al. In a study involving 20 individuals with claustrophobia, those told to concentrate on their bodily sensations while in an enclosed chamber reported signifcantly higher fear and panic scores, and experienced a higher rate of panic attacks than individuals in the control (distraction) group (Rachman, Levitt, & Lopatke, 1988). Strenuous physical exercise is a naturalistic situation that normally increases attention to physical state. Furthermore, vigorous exercise increases blood lactate levels, which individuals with panic might fnd less tolerable given their heightened reactivity to sodium lactate infusion (Liebowitz et al. So, one might expect panic patients to be less tolerant of strenuous physical exercise. Interestingly, it appears that individuals with panic disorder are able to engage in vigorous physical exercise without experiencing thoughts or feelings indicative of panic even though the exercise produces blood lactate levels that are equal to or greater than those attained in lactate infusion studies (Martinsen, Raglin, Hoffart, & Friis, 1998). Although individuals with panic disorder may have greater physiological reactivity such as a elevated respiratory rate, heart rate, and blood pressure, and lower skin temperature during biological provocations that induce bodily sensations (J. On the other hand, differences in perceived intensity and distress of the physical sensations produced by these biological challenges have been robust and quite consistent across studies. In a recent study Story and Craske (2008) found that individuals at risk for panic (high anxiety sensitivity and a history of panic attacks) reported signifcantly more panic symptoms following false elevated heart-rate feedback than low-risk individuals, even though there were no group differences in actual heart rate. Together these fndings provide strong evidence for the cognitive perspective on panic disorder, suggesting that the main difference is in the perception and interpretation of physical changes rather than in actual physiological responses. Moreover, it is clear that contextual factors affect response to physical sensations and their interpretation.

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Many paby nature a self-limited illness, acute stress disorder tients stop taking their medicine because they develop (see page 24) also responds to short-term therapy. Side effects are more common with alized anxiety disorder, panic disorder, and obsessivesome medications than others. In general, newer drugs with fewer or milder side effects are replacing those with more, or more severe, side effects. The latter term is a misnomer because ment for many anxiety disorders during the 1990s. The they are no longer the only kinds of drugs that have serotonin system is active in many regions of the brain, antianxiety properties. In fact, antidepressants have affecting anxiety, mood, arousal, impulses, and aggresbecome the first choice for many anxiety disorders. Benzodiazepines alprazolam (Xanax) Generalized anxiety disorder, Clumsiness or unsteadiness, drowsiclonazepam (Klonopin) panic disorder, specific ness, cognitive impairment, dizziness, lorazepam (Ativan) phobias headache. Azapirone Derivative buspirone (BuSpar) Generalized anxiety disorder Chest pain, dizziness, headache, nausea Beta Blocker propranolol (Inderal) Performance anxiety (a Dizziness, slight drowsiness, social phobia) erectile dysfunction 32 A Special Health Report from Harvard Medical School 32 it. This prolongs the time that the serotonin can work for generalized anxiety disorder and post-traumatic at receptor sites. They can cause are thought to relieve anxiety and depression mainly sexual dysfunction, weight gain, and insomnia. Someby increasing the availability of norepinephrine and times they even temporarily heighten anxiety symptoms. What can cause side effects that are more numerous and more induces side effects in one person may not cause any severe, including dizziness, constipation, blurred vision, problems in another. To a lesser degree, the drug also disorder, obsessive-compulsive disorder, post-traumatic blocks the reabsorption of a third neurotransmitter instress disorder, and panic disorder. But in someone with an anxiety disorder, the cell that released the serotonin may reabsorb it too quickly. As a result, there may not be enough serotonin available to bind to the next cell and allow the signal to pass.

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On rare occasions, seizures after mild trauma are seen risk to develop late seizures compared to a 13% risk after in the context of a pre-existing brain pathology (37,38), a conbrief symptomatic seizures. It remains unclear if this is related stellation called pseudotraumatic epilepsy (39). Effective prevention might need a clear target, appromerely suppress the seizures. Most of our understanding of the priate timing, and should not interfere with adaptive processes cellular and molecular mechanisms of epileptogenesis derives necessary for functional recovery (48). One seizures; based on the Cochrane estimate, for every example of a more specific epileptogenic process is early 100 patients treated, 10 would be kept seizure-free in the first symptomatic seizure or status after head trauma that could week (65,66). Phenytoin may be initiated as an intraBased on the fluid percussion model, either a selective loss of venous loading dose as soon as possible after the injury. Data hilar interneurons in the dentate gyrus or a relative survival of on newer antiepileptic medications for the prophylaxis of irritable mossy fibers, may lead to persistent granule cell early seizures after severe head trauma are limited. A more recent study demonstrated Levetiracetam has been used in this indication and one obserthat focal brain injury after a single episode of fluid percussion vational study suggests that it may be similarly effective as injury is able to trigger spontaneous seizures (58), which origphenytoin with easier use and less side effects (66,68). There inate from the site of injury and become clinically and electroare insufficient data to make recommendations on the use of graphically more severe over time (59,60). Isolation of a small cortical region by transecting the white Current evidence does not support the routine use of matter with a needle leads to epileptiform activity of the antiepileptic drugs beyond the first 7 days after the injury. Axonal sprouting of the isolated pyramidal cells prevent late post-traumatic seizures, and early treatment with is associated with an increased number of excitatory connecsteroids has been shown to increase seizure activity (73). Early application of tetrodotoxin after the injury Medical prophylaxis of late post-traumatic seizures is curblocks action potentials and prevents the development of rently not recommended.

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