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Depression & Anxiety:Depression & Anxiety:

Evaluation & Behavioral TreatmentEvaluation & Behavioral Treatment

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Chronic PainChronic Pain

Kenneth J Devlin, MAKenneth J Devlin, MA

Licensed PsychologistLicensed Psychologist

Center for Pain ReliefCenter for Pain Relief

St. MarySt. Mary’’s Medical Centers Medical Center2

Changing West VirginiaChanging West Virginia

� Chronic disease

� Obesity

� Mood/anxiety disorders

� Work injuries

� Absenteeism

� Medical & insurance

costs

� Motor vehicle accidents

� School performance

� Overall health

� Cognitive functioning

� Work performance

� Quality of life

� Overall mortality rates

Reduce: Improve:

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Health PsychologyHealth Psychology

An Integrated Approach

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The Island Where People Forget to DieThe Island Where People Forget to Die

The New York Times

By Dan Buettner5

S L E E PS L E E P

Our Repair & Maintenance Cycle

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Snooze AlertSnooze 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

NIH Publication No. 06-5271 November 2005

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Snooze AlertSnooze Alert

•Sleep & Hormones• Normal sleep:

– 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. 06-5271 November 2005

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Sleep Deprivation Impairs Sleep Deprivation Impairs

Cognitive Abilities & MoodCognitive 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.

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Health Consequences of Inadequate Health Consequences of Inadequate

or Poor Sleepor 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.

Snooze AlertSnooze 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. 06-5271 November 2005

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Snooze AlertSnooze 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): 294-302. Epub 2007 Dec 21.

8 Mar, 42 (3): 294-302. Epub 2007 Dec 21.

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Behavioral Treatments for InsomniaBehavioral Treatments for Insomnia

•Stimulus Control

• Sleep Restriction

•Cognitive Behavioral Therapy

•Relaxation Training

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Case StudyCase 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): 64-5.

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Snooze AlertSnooze 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 Michigan15

Snooze AlertSnooze 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): 837-41.

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Snooze AlertSnooze 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, 1999

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Exercise & MoodExercise & Mood

• Leisure-time exercise can offer reliable reductions in anxiety while also

promoting feelings of wellbeing

• In one study, 10 weeks of exercise 30-40 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

Exercise & MoodExercise & 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". www.health.harvard.edu/UDwww.health.harvard.edu/UDwww.health.harvard.edu/UDwww.health.harvard.edu/UD 19

Making It WorkMaking It Work

•Education

•Motivation

•Cognitive Behavioral Strategies

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Evaluation & Behavioral Treatment of Anxiety & Depression Evaluation & Behavioral Treatment of Anxiety & Depression

inin

Chronic PainChronic Pain

Kenneth J Devlin, Kenneth J Devlin, MAMA

Licensed PsychologistLicensed Psychologist

Center for Pain Relief Center for Pain Relief

St. MarySt. Mary’’s Medical Centers Medical Center