Self-Care

Self-care is any activity that nurtures and refuels you in a meaningful way.  Self-care is particularly important following a major illness like autoimmune encephalitis.  Engaging in activities that support our well being is critical to renewing energy, health and wellness.  We all have many aspects of our lives that make us healthy and whole.  These areas of our lives require attention and personal care:

• Physical
• Emotional and mental
• Spiritual
• Self-awareness
• Relationship to others
• Career

• Take time each week to check in with yourself and identify which areas need support.
• Choose the activities you will engage in on a weekly basis.
• Schedule time in your calendar for each item.
• Enlist the support of friends and family for those items that require extra accountability.
• Trust and empower the people you care for to take care of themselves so that you can take care of yourself.
• Make it easier for yourself by making your environment conducive to your activities.
• Be present during self-care practices.
• Start small and build on practices that best serve you over time.

Setbacks will occur in your practice of self-care.  The key is to remain determined and focused on your own health and wellbeing, even in the midst of trials.  Give yourself the gift of time to renew your spirit and replenish your energy.

An important aspect of practicing good self-care is an awareness of how your mind impacts your body.  This key connection is critical in managing stress, mental clarity, attitude, and overall health.  There are many types of mind and body practices designed to assist in balancing those connections, reducing stress, and improving overall well-being.  The following practices are common complimentary tools to conventional medicine to aid in health and wellness.  (References provided by Duke Integrative Medicine Health Coaching program.)

Acupuncture

Acupuncture is the insertion of hair-thin needles into the skin at specific locations, or channels, on the body. According to traditional Chinese medicine, each channel links to a specific organ system.  Conventional medical practitioners believe that the needles cause the brain or spinal cord to release chemicals that help with pain management and bolster immune function.   An acupuncture session is typically done within a half hour.  Research studies suggest that acupuncture may be helpful in treating:  anxiety, pain in the head, back and neck, osteoarthritis pain, nausea related to cancer treatment, pain after surgery.   Side effects are rare.

Related References:

1. 1. 1. de Lorent L, Agorastos A, Yassouridis A, Kellner M, Muhtz C. Auricular Acupuncture Versus Progressive Muscle Relaxation in Patients with Anxiety Disorders or Major Depressive Disorder: A Prospective Parallel Group Clinical Trial. J Acupunct Meridian Stud. 2016;9(4):191-199.
      2. Vickers AJ, Cronin, A M, Maschino, A C, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. 2012;172(19):1444-1453.
      3. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database of Systematic Reviews. 2009(1):CD007587.
      4. Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN. Acupuncture for patients with chronic neck pain. Pain. 2006;125(1-2):98-106.
      5. Ezzo J, Richardson, M A, Vickers, A, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews. 2006(2):CD002285.

Art Therapy

Art therapy utilizes art to help people cope with symptoms of disease, stress, and traumatic experiences.  Art can provide a creative outlet to adults and children that can reduce stress and stimulate healing.  Art therapy may also help people discover connections between their physical health, their emotions, and their thoughts. There are a variety of art mediums used in art therapy including painting, drawing, sculpting, and mixed media materials.  Some studies suggest that art therapy can:  reduce anxiety and depression in cancer patients, assist with physical and emotional trauma, help in the management of schizophrenia or dementia, aid in learning difficulties, lower stress in family caregivers.

Related References:

1. 1. 1. Boehm K, Cramer H, Staroszynski T, Ostermann T. Arts Therapies for Anxiety, Depression, and Quality of Life in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine. 2014;2014(Article ID 103297).
      2. Smyth JM, Hockemeyer JR, Tulloch H. Expressive writing and post‐traumatic stress disorder:  Effects on trauma symptoms, mood states, and cortisol             reactivity. British Journal of Health Psychology. 2010;13(1):85-93.
      3. Cowl AL, Gaugler JE. Efficacy of Creative Arts Therapy in Treatment of Alzheimer’s Disease and Dementia: A Systematic Literature Review. Activities, Adaptation & Aging. 2014;38(4):281-330.
      4. Richardson P, Jones K, Evans C, Stevens P, Rowe A. Exploratory RCT of art therapy as an adjunctive treatment in schizophrenia. Journal of Mental Health. 2007;16(4):483-491.
      5. Walsh SM, Martin SC, Schmidt LA. Testing the efficacy of a creative-arts intervention with family caregivers of patients with cancer. Journal of Nursing Scholarship. 2004;36(3):214-219.
      6. Favara-Scacco C, Smirne G, Schilirò G, Di Cataldo A. Art therapy as support for children with leukemia during painful procedures. Medical Pediatric Oncology. 2001;36(4):474-480.

Biofeedback

Biofeedback involves training the mind to change the body’s reactions. Patients are connected to equipment that measures certain body functions such as breath rate and blood pressure. This equipment allows patients to see how their bodies react to their behavior or thought processes. As patients try to control these reactions, they can see immediately if there are any changes. In time, patients learn to change their reactions, lowering stress and pain or reducing symptoms of disease.

Some studies suggest that biofeedback can help treat: alcoholism and substance abuse, anxiety, attention deficit hyperactivity disorder (ADHD), headaches, diabetes, epilepsy, high blood pressure, temporomandibular joint disorder (TMJ).   Biofeedback is considered safe for most people; however, the small amount of electricity used by the equipment may affect a pacemaker.

Related References:

1. 1. 1. Moore NC. A Review of EEG Biofeedback Treatment of Anxiety Disorders. Clinical Electroencephalography. 2000;31(1):1-6.
      2. Monastra VJ, Lynn S, Linden M, Lubar JF, Gruzelier J, La Vaque TJ. Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder. Journal of Neurotherapy. 2008;9(4):5-34.
      3. Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: A meta-analysis. Pain. 2007;128(1-2):111-127.
      4. Andrasik F. Biofeedback in headache: An overview of approaches and evidence. Cleveland Clinic Journal of Medicine. 2010;77(Supplement 3):S72-S76.
      5. Tan G, Thornby J, Hammond DC, et al. Meta-Analysis of EEG Biofeedback in Treating Epilepsy. Clinical EEG and Neuroscience. 2009;40(3):173-179.
      6. Wang S-Z, Li S, Xu X-Y, et al. Effect of Slow Abdominal Breathing Combined with Biofeedback on Blood Pressure and Heart Rate Variability in Prehypertension. The Journal of Alternative and Complementary Medicine. 2010;16(10):1039-1045.

Chiropractic

Chiropractic is a type of practice that that focuses on the spinal cord and its impacts to illness.  Chiropractors treat illness by adjusting the spine to enable the nervous system to work better. Chiropractors may use other treatment methods as well. Chiropractic therapy may cause your body to release chemicals that affect how you feel pain and pleasure.  Some studies suggest that chiropractic can help treat: back pain, headaches, neck pain.   (Please note that while serious side effects are rare, chiropractic is not recommended for patients with bone cancer or diseases of the spinal cord or bone marrow.)

Related References:

1. 1. 1. Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ. 1995;311(7001):349.
      2. Bronfort G, Assendelft WJJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: A systematic review. Journal of Manipulative and Physiological Therapeutics. 2001;24(7):457–466.
      3. Palmgren PJ, Sandstrom PJ, Lundqvist FJ, Heikkila H. Improvement After Chiropractic Care in Cervicocephalic Kinesthetic Sensibility and Subjective Pain Intensity in Patients with Nontraumatic Chronic Neck Pain. Journal of Manipulative and Physiological Therapeutics. 2006;29(2):100-106.

Dance/Movement Therapy

Dance/movement therapy is based on the concept that the mind and body are intricately connected and therefore your thoughts or feelings can impact your health in both positive and negative ways. Dance/movement therapy is believed to increase self-esteem and self-confidence, reduce pain related to chronic muscle tension, improve coordination, and help make your heart and lungs stronger. Dance/movement therapy can be conducted in group or one-on-one settings.  Some studies suggest that dance/movement therapy can help treat: anxiety, autism, cystic fibrosis, dementia, depression, Parkinson’s disease, schizophrenia.

Related References:

1. 1. 1. Koch S, Kunz T, Lykou S, Cruz R. Effects of dance movement therapy and dance on health-related psychological outcomes: A meta-analysis. The Arts in Psychotherapy. 2014;41(1):46-64.
      2. Johnson SK, Frederick J, Kaufman M, Mountjoy B. A Controlled Investigation of Bodywork in Multiple Sclerosis. The Journal of Alternative and Complementary Medicine. 2007;5(3):237-243.
      3. Ullmann G, Williams HG, Hussey J, Durstine JL, McClenaghan BA. Effects of Feldenkrais Exercises on Balance, Mobility, Balance Confidence, and Gait Performance in Community-Dwelling Adults Age 65 and Older. The Journal of Alternative and Complementary Medicine. 2010;16(1):97-105.

Guided Imagery

Guided imagery involves what you see, hear, smell, taste, and feel in your imagination. Research indicates that imagery can change your heart rate, blood pressure, and other actions in your body. Guided imagery is used in managing a variety of health concerns such as high blood pressure or stress management.  Practitioners utilize guided imagery in managing a range of diseases including cancer.    Some studies suggest that guided imagery can help treat: asthma headaches, osteoarthritis pain, post-stroke paralysis, symptoms of Parkinson’s disease.

Related References:

1. 1. 1. Lahmann C, Nickel M, Schuster T, et al. Functional Relaxation and Guided Imagery as Complementary Therapy in Asthma: A Randomized Controlled Clinical Trial Psychotherapy and Psychosomatics. 2009;78:233-239.
      2. Mannix LK, Chandurkar RS, Rybicki LA, Tusek DL, Solomon GD. Effect of Guided Imagery on Quality of Life for Patients With Chronic Tension‐Type Headache. Headache. 2002;39(5):326-334.
      3. Baird CL, Sands LP. Effect of guided imagery with relaxation on health‐related quality of life in older women with osteoarthritis. Research in Nursing & Health. 2006;29(5):442-451.
      4. Liu KP, Chan CC, Lee TM, Hui-Chan C. Mental imagery for promoting relearning for people after stroke: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2004;85(9):1403-1408.
      5. Schlesinger I, Benyakov O, Erikh I, Suraiya S, Schiller Y. Parkinson’s disease tremor is diminished with relaxation guided imagery. Movement Disorders. 2009;24(14):2059-2062.

Healing Touch

Healing Touch (HT) is an energy therapy that is used largely by nursing professionals. HT providers use light touch near or on the client’s clothed body. People often report feeling deeply relaxed during and after a session. HT augments standard medical care in some hospitals, long-term care facilities, and private practices.  HT providers seek to improve the patient’s innate healing abilities and improve their overall sense of well-being by balancing the patient’s energy field.  Some studies suggest that HT can help reduce: stress, recovery time following surgery, fatigue in cancer patients, chronic headaches.

Related References:

1. 1. 1. 1. Wilkinson DS, Knox PL, Chatman JE, et al. The Clinical Effectiveness of Healing Touch. The Journal of Alternative and Complementary Medicine. 2004;8(1):33-47.
         2. MacIntyre B, Hamilton J, Fricke T, Ma W, Mehle S. The Efficacy of Healing Touch in Coronary Artery Bypass Surgery Recovery: A Randomized Clinical Trial. Alternative Therapies in Health and Medicine. 2008;14(4):24-32.
         3. Post-White J, Kinney ME, Savik K, Berntsen Gau J, Wilcox C, Lerner I. Therapeutic Massage and Healing Touch Improve Symptoms in Cancer. Integrative Cancer Therapies. 2003;2(4):332-344.
         4. Sutherland EG, Ritenbaugh C, Kiley SJ, Vuckovic N, Elder C. An HMO-Based Prospective Pilot Study of Energy Medicine for Chronic Headaches: Whole-Person Outcomes Point to the Need for New Instrumentation. The Journal of Alternative and Complementary Medicine. 2009;15(8):819-826.

Massage Therapy

Massage therapists rub and knead the body’s soft tissues. There are many types of massage including Swedish, shiatsu, Thai, and Chinese tuina.  Massage helps your muscles relax, reducing stress or symptoms worsened by muscle tension such as headaches, backaches, and sleep disturbances.  Patients with serious disease often find that massage improves their outlook and overall well-being. Massage therapy is typically conducted in sessions lasting between 30 and 90 minutes.  Some studies suggest that massage therapy can help treat: anxiety and depression, back pain, knee arthritis, migraines, neck pain, pain from surgery.  (Please note that massage therapy is contraindicated in certain medical conditions such as bone metastases, infections, circulatory problems or following some surgeries.  Consult your medical provider to ensure massage is safe for you.)

Related References:

1. 1. 1. Field T, Ironson G, Scafidi F, et al. Massage Therapy Reduces Anxiety and Enhances Eeg Pattern of Alertness and Math Computations. International Journal of Neuroscience. 1996;86(3-4):197-205.
      2. Cherkin DC, Sherman KJ, Kahn J, et al. A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial. Annals of internal medicine. 2011;155(1):1-9.
      3. Perlman A, Sabina A, Williams A, Y NV, Katz D. Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial. JAMA. 2006;166(22):2533-2538.
      4. Lawler S, Carmeron L. A randomized, controlled trial of massage therapy as a treatment for migraine. Annals of Behavioral Medicine. 2006;32(1):50-59.
      5. Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA. Randomized Trial of Therapeutic Massage for Chronic Neck Pain. Clinical Journal of Pain. 2009;25(3):233-238.
      6. Bauer BA, Cutshall SM, Wentworth LJ, et al. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: A randomized study. Complementary Therapies in Clinical Practice. 2009;16(2):70-75.

Meditation & Mindfulness

Meditation often involves focusing on breathing or repeated words or phrases. While many forms of meditation originate in Eastern or Western religious practice, many people outside of these practices use meditation to clear their minds of anxiety inducing thoughts, relax tense muscles, and encourage a positive emotional state.  Regular meditation is thought to slow age related brain decline, lower blood pressure, relax breathing rates, and increase healthy blood flow.  To get the full benefits of meditation, try it once or twice a day for at least 10–20 minutes.   Some studies suggest that meditation can help: anxiety and depression, arthritis, ADHD, back pain, heart disease, high blood pressure, hot flashes, irritable bowel syndrome.  (Though meditation is considered safe for most people, people at risk of mental illness should talk to their medical provider before starting meditation.)

Related References:

1. 1. 1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. Journal of consulting and clinical psychology. 2010;78(2):169-183.
      2. Rosenzweig S, Greeson J, Reibel D, Green J, Jasser S, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of psychosomatic research. 2010;68(1):29-36.
      3. Mitchell J, McIntyre EM, English JS, Dennis MF, Beckham JC, Kollins SH. A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation. Journal of Attention Disorders. 2017;21(13):1105-1120.
      4. Parswani MJ, Sharma MP, Iyengar SS. Mindfulness-based stress reduction program in coronary heart disease: A randomized control trial. International Journal of Yoga. 2013;6(2):111-117.
      5. Carmody J, Crawford S, Salmoirago-Blotcher E, Leung K, Churchill L, Olendzki N. Mindfulness Training for Coping with Hot Flashes: Results of a Randomized Trial. Menopause. 2011;18(6):611-620.
      6. Keefer L, Blanchard EB. The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study. Behaviour Research and Therapy. 2001;39(7):801-811.

Music Therapy

Music therapy has long been used in stress reduction and healing. Music therapy can be utilized in patients of any age and at any stage of illness. Music therapy may include listening to music, playing instruments, singing, or writing lyrics and music.  Listening to slow and relaxing music has been found to lower heart rate, blood pressure, and breathing rate whereas music with a lively beat can improve energy. Research also suggests that music can affect the hormones in your body, reducing pain and stress levels, and improving the immune system.  Some studies suggest that music therapy can help treat: anxiety and depression, autism, chronic pain, dementia, sleep disturbances, neurological problems.

Related References:

1. 1. 1. Aalbers S, Fusar-Poli L, Freeman RE, et al. Music therapy for depression. Cochrane Database of Systematic Reviews. 2017(11).
      2. Wigram T, Gold C. Music therapy in the assessment and treatment of autistic spectrum disorder: clinical application and research evidence. Child: care, health and development. 2006;32(5):535-542.
      3. Nickel AK, Hillecke T, Argstatter H, Bolay HV. Outcome Research in Music Therapy: A Step on the Long Road to an Evidence‐Based Treatment. Annals of the New York Academy of Sciences. 2005;1060(1):283-293.
      4. Koger SM, Chapin K, Brotons M. Is Music Therapy an Effective Intervention for Dementia? A Meta-Analytic Review of Literature. Journal of Music Therapy. 1999;36(1):2-15.
      5. Harmat L, Takacs J, Bodizs R. Music improves sleep quality in students. Journal of Advanced Nursing. 2008;62(3):327-335.
      6. Lai H, Good M. Music improves sleep quality in older adults. Journal of Advanced Nursing. 2005;49(3):234-244.
      7. Thaut MH, Gardiner JC, Holmberg D, et al. Neurologic Music Therapy Improves Executive Function and Emotional Adjustment in Traumatic Brain Injury Rehabilitation. Annals of the New York Academy of Sciences. 2009;1169(1):406-41.

Reiki

Reiki (pronounced ray-key) is a spiritual healing practice that seeks to restore balance. Providers place their hands above or lightly on the patient’s body to send subtle energy to the patient. The patient remains fully clothed and often lies on a padded table. It is believed that Reiki increases a person’s level of peace, balance, and relaxation.   Some studies suggest that Reiki can help reduce: behavioral and memory problems in people with mild Alzheimer’s disease, pain and anxiety, symptoms of depression.

Related References:

1. 1. 1. Crawford SE, Leaver VW, Mahoney SD. Using Reiki to Decrease Memory and Behavior Problems in Mild Cognitive Impairment and Mild Alzheimer’s Disease. The Journal of Alternative and Complementary Medicine. 2006;12(9):911-913.
      2. Richeson NE, Spross JA, Lutz K, Peng C. Effects of Reiki on Anxiety, Depression, Pain, and Physiological Factors in Community-Dwelling Older Adults. Research in Gerontological Nursing. 2010;3(3):187-199.
      3. Thrane S, Cohen SM. Effect of Reiki Therapy on Pain and Anxiety in Adults: An In-Depth Literature Review of Randomized Trials with Effect Size Calculations. Pain Management Nursing. 2014;15(4):897-908.

Yoga

Yoga is practiced to connect the mind, body, and spirit. When practiced regularly, it can help people relax, reduce stress, strengthen their bodies, and improve flexibility. Those who practice Yoga report improved sleep, mood and overall sense of well-being.  Certain yoga practices have also been found to strengthen bones, improve bone density and reduce the risk of falls in older people.  Some studies suggest that yoga may be useful in the treatment of: anxiety, depression and insomnia, arthritis, carpal tunnel syndrome, chronic low back pain, diabetes, high blood pressure, osteopenia and osteoporosis, symptoms of menopause. 

Related References:

1. 1. 1. Tekur P, Nagarathna R, Chametcha S, Hankey A, Nagendra HR. A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: An RCT. Complementary therapies in medicine. 2012;20(3):107-118.
      2. Shapiro D, Cook IA, Davydov DM, Ottaviani C, Leuchter AF, Abrams M. Yoga as a Complementary Treatment of Depression: Effects of Traits and Moods on Treatment Outcome. Evidence-Based Complementary and Alternative Medicine. 2007;4(4):493-502.
      3. Manjunath NK, Telles S. Influence of Yoga & Ayurveda on self-rated sleep in a geriatric population. Indian Journal of Medical Research. 2005;121(5):683-690.
      4. Wren AA, Wright MAC, J W, Keefe FJ. Yoga for Persistent Pain: New Findings and Directions for an Ancient Practice. Pain. 2011;152(3):477-480.
      5. Singh S, Kyizom T, Singh KP, Tandon OP, Madhu SV. Influence of pranayamas and yoga-asanas on serum insulin, blood glucose and lipid profile in type 2 diabetes. Indian Journal of Clinical Biochemistry. 2008;23(4):365-368.
      6. Hagins M, States R, Selfe T, Innes K. Effectiveness of Yoga for Hypertension: Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine. 2013;2013(Article ID 649836):13 pages.
      7. Booth-LaForce C, Thurston RC, Taylor MR. A pilot study of a Hatha yoga treatment for menopausal symptoms. Maturitas: The European Menopause Journal. 2007;57(3):286-295.

Below is a list of common mind and body practices and related professional organization websites from which you can learn more information.