The Practice of Self-Care
 
Steven Mandel MD
Professor of Neurology
Zucker School of Medicine at Hofstra/Northwell
 
Heidi Mandel PhD, LMSW
Social Work Supervisor The Jewish Board

If I am not for myself, who will be for me? Hillel, the elder, was asked by his students, “Why are you walking?”  He indicated that caring for oneself, in body, mind and spirit, allows one to care for others. Hillel walked to take a break, take time off for exercise and Self-contemplation and spiritual renewal.
 
In May 2019, the World Health Organization issued a guideline for risk reduction of cognitive decline and dementia. The WHO indicated that physical activity, healthy eating, abstinence from smoking, and maintaining healthy blood pressure, cholesterol, blood sugar levels and reduced use of alcohol can significantly lower the risk of developing dementia and cognitive impairment.
 
As self-caregivers, we must follow Rabbi Hillel’s statement that we are created in God’s image, and, therefore, by self-care, we show respect for God.  Taking time off brings strengthening our mind in terms of improving concentration, clarity and managing stress.  We will raise our energy and boost our immunity. We will slow our breathing, calming the mind and spirit.  We can stabilize our emotions and feel more peaceful and tranquil, especially on Shabbat.
 
Living a life with too much stress is an impediment to our relationship with God. We need to examine our work schedules, family and friendships for sources of stress and conflicts. We need to set boundaries for better time management. Self-care is beneficial for ones health and increases a self-awareness of well being. We need to have a balance between work and recreation.  We need to learn how to delegate, relax, laugh and develop more coping skills than we already possess.
 
On the other hand, hallmarks of burnout include: emotional exhaustion, depersonalization, and lowered productivity.  The Maslach Burnout Inventory consists of questions in three categories that describe the extent of burnout for any individual.  The categories are:  Depersonalization, Emotional Exhaustion, Personal Accomplishment.  Lack of exercise poses a risk for cognitive decline. Avoiding obesity with a healthy Mediterranean diet is recommended. Mild cognitive impairment includes changes in memory, personality changes, overall increasing anxiety and depression. Sleep can be affected negatively.
 
Healthy recommendations include:  walking, learning something new, making new friends (younger and older) reading, hobbies, movies, gardening, meditating, travel, reducing work stress and hours.
 
The renewal of the mind, body and spirit will improve brain health and function.  In summary, self-care involves attention to the emotional, physical, and spiritual.

Hypnosis for Pain Management
By Sandy Victor

Sandy Victor is a Certified Hypnotist/Hypnotherapist by the National Guild of Hypnotists in a private practice.  I am located in Buffalo Grove, IL, and have been doing hypnosis for over 40 years mainly for personal improvement matters.  For more information, contact me at - sandy_victor@hotmail.com, www.SandyVictorHypnosis.com and (847) 634-1376.

This is the third in a series of articles on the use of hypnosis to improve the life of individuals with commonly presented issues:

Pain Management

The use of hypnosis to reduce or eliminate pain is one of the most scientifically studied topics by many researchers.  Many different kinds of pains have been studied.  This article addresses many of the studies that have been made for specific types of pain management.  Pain takes many forms and impacts many parts of the body.  It can be defined as a localized or generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease). Pain that persists for longer than 6 months is referred to as chronic pain. Unrelieved chronic pain can cause considerable suffering, physical limitations, and emotional distress. Further, chronic pain is one of the most common reasons for seeking medical care but often persists despite treatment with analgesics and physical modalities.  Hypnosis has been shown to offer help for all these types of pain management.

There is a wonderful article on International Journal Clinical Experimental Hypnosis. 2007 Jul; 55(3): 275–287, Hypnotherapy for the Management of Chronic Pain by Gary Elkins, Mark P. Jensen, and David R. Patterson.  This article reviews thirteen controlled trials of hypnosis for the treatment of chronic pain. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than nonhypnotic interventions such as attention, physical therapy, and education. The following is a summary of the use of hypnosis in the treatment of several chronic pain problems.

Cancer Pain

Spiegel and Bloom (1983) assigned women with chronic cancer pain from breast carcinoma to either standard care or weekly expressive-supportive group therapy for up to 12 months. The women randomized to the group therapy condition were assigned to groups that either did or did not have self-hypnosis training as a part of their treatment. The hypnosis intervention was directed toward enhancing patient competence and mastery in managing pain and stress related to cancer. Hypnotic training included suggestions to “filter out the hurt” of any sensations by imagining competing sensations in affected areas. Patients were also given instructions for using self-hypnosis outside of the group-therapy sessions. Both treatment groups demonstrated significantly less pain and suffering than the control sample.

Low-Back Pain

McCauley et al. (1983) conducted a prospective trial comparing hypnosis and relaxation training for chronic low-back pain. Seventeen outpatients were assigned to either self-hypnosis or relaxation. The baseline was an EMG-assessment session and 1 week later the patients began eight individual weekly sessions. Patients were assessed 1 week after the completion of treatment and then again 3 months after the treatment ended. Patients in both groups were found to have significant reductions in pain as measured by the McGill Pain Questionnaire and visual analog ratings of pain. Patients given the hypnosis intervention reported significant pre- to posttreatment. However, both the hypnosis intervention and relaxation were effective; neither proved to be superior to the other.

Arthritis Pain

Gay et al. (2002) compared the effectiveness of hypnosis and Jacobson relaxation for the reduction of osteoarthritis pain. Thirty-six patients with osteoarthritis pain were randomly assigned to one of three conditions: hypnosis, relaxation training, and a no-treatment/standard-care control condition. The hypnosis intervention consisted of eight weekly sessions that began with a standard relaxation induction followed by suggestions for positive imagery, as well as a memory from childhood that involved joint mobility. The subjects in the standard-care control condition were administered the outcome measures and were offered treatment after their last follow-up assessment. Patients in the hypnosis treatment showed a substantial and significant decrease in pain intensity. However, although significant differences between the hypnosis and the standard-care control condition were found mid-treatment, posttreatment, and at follow-up, the differences between the effects of the hypnosis intervention and the relaxation control on pain reduction were not statistically different.

Sickle Cell Disease

Dinges et al. (1997) enrolled children and adults with sickle cell disease (SCD) who reported experiencing episodes of vaso-occlusive pain into a prospective 2-year treatment protocol. A pre- and post-experimental design was used and participants were asked to complete daily diaries. Results indicated the self-hypnosis intervention was associated with a significant reduction in the number of pain days.

Temporomandibular (TMJ) Pain

Temporomandibular disorder can be associated with chronic pain related to dysfunction of the masticatory musculature, the temporomandibular joint, or both. Simon and Lewis (2000) examined the effectiveness of hypnosis on temporomandibular pain disorder. Measures of pain symptoms (pain intensity, duration, and frequency) were assessed on four separate occasions: during wait list, before treatment, after treatment, and at 6-month follow-up. The hypnosis intervention consisted of education about hypnosis and five sessions that involved an eye-closure induction, relaxation imagery, suggestions for limb catalepsy, metaphors, suggestions for hypnotic analgesia and anesthesia suggestions, and suggestions that muscle tension would serve as a cue for relaxation. Patients were also instructed to practice self-hypnosis daily with audiotaped recordings of the hypnotic treatment. The results indicated a significant decrease in pain frequency, pain duration, and an increase in daily functioning. Analyses also suggested that the treatment gains were maintained for 6 months after treatment with reduced pain and improved daily functioning.

Fibromyalgia

In a controlled study, Haanen et al. (1991) randomly assigned patients with fibromyalgia to groups that received either eight 1-hour sessions of hypnotherapy with a self-hypnosis home-practice tape over a 3-month period, or physical therapy (that included massage) and muscle relaxation training) for 3 months. Outcome was assessed pre- and posttreatment and at 3-month follow-up. Compared with patients in the physical therapy group, the patients who received hypnosis showed significantly better outcomes on measures of muscle pain, fatigue, sleep disturbance, distress, and patient overall assessment of outcome. These differences were maintained at the 3-month follow-up assessment and the average percent decrease in pain among patients who received hypnosis was clinically significant, whereas the percent decrease in the patients who received physical therapy was marginal.

Disability-Related Pain

Jensen et al. (2005) examined the effects of 10 sessions of standardized (script-driven) hypnotic analgesia treatment on pain intensity, pain unpleasantness, depression, and perceived control over pain in patients with chronic pain secondary to a disability. Analyses indicated significant pre- to posttreatment improvement in pain intensity, pain unpleasantness, and perceived control over pain (but not depressive symptoms) over and above change that occurred during the baseline period. Improvement was also maintained at the 3-month follow-up.

Mixed Chronic-Pain Problems

Melzack and Perry (1975) examined the effects of hypnosis and neurofeedback in patients who had a variety of chronic-pain problems. Baseline data was collected during two no-treatment (baseline) sessions, and patients were then randomly assigned to one of three treatment conditions: four sessions of hypnosis alone, eight sessions of neurofeedback training alone, or both hypnosis and neurofeedback training. There was a reduction in pain observed during the hypnosis training, however, none of the observed changes in either the neurofeedback or hypnosis conditions were statistically significant in comparison to the baseline phase.

Edelson and Fitzpatrick (1989) evaluated hypnosis and cognitive-behavior therapy for treatment of chronic pain. Patients with various chronic-pain problems (back pain being the most frequent) were randomly assigned to: cognitive-behavioral therapy (CBT) alone, CBT plus hypnosis treatment, or an attention control (supportive, nondirective discussions). The hypnosis and CBT treatments were identical with the exception of a hypnotic induction. It is noteworthy, however, that the CBT intervention used in this study included some what might be considered “hypnotic components.” The results indicated decreases in pain intensity for both the hypnosis intervention and the CBT treatment that were sustained at 1-month follow-up.

Appel and Bleiberg (2005–2006) investigated the association between hypnotizability and hypnosis for treatment of chronic pain. Twenty-seven patients with a variety of chronic-pain problems received hypnosis treatment sessions directed at “teaching self-regulation of the affective and sensory components of pain.” The word hypnosis was not mentioned during the intervention, which included relaxation training, autogenic statements, guided imagery for pain alteration and health and healing, and individualization to use images “in a way that is best for him or her.” The results indicated a significant reduction in pain ratings pre- and posttreatment. Changes in pain ratings were significantly correlated with hypnotizability as measured by the Stanford Clinical Hypnotic Scale.

Headaches & Migraines

A total of 8 additional studies were identified that examined hypnotic techniques either alone or in combination with other nonpharmaceutical techniques, such as visual imagery, relaxation, and pain-displacement techniques. These studies demonstrate that hypnosis and relaxation techniques are effective in reducing short-term and long-term headache activity in migraine sufferers.

Child Birth

Researchers have long examined the medical benefits of hypnosis. And there’s a significant amount of evidence that shows a range of benefits, including: less reliance on pain medication (fewer epidurals), shorter hospital stays, improved pain tolerance, more positive experiences, shorter labors, fewer surgical interventions.

Summary

A review of published articles on studies that evaluated the efficacy of hypnosis for chronic pain. The studies show that hypnosis intervention was significantly more effective than a no-treatment condition in reducing chronic-pain. Moreover, the efficacy of hypnosis in reducing pain was consistently confirmed for a wide variety of different chronic-pain conditions (e.g., cancer, low-back pain, arthritis pain, sickle cell disease, temporomandibular pain, disability-related pain, and headaches including migraines).  Child birth experiencing less pain and fewer drugs is also documented.

References

Appel PR, Bleiberg J. Pain reduction is related to hypnotizability but not to relaxation or to reduction of suffering: A preliminary investigation. American Journal of Clinical Hypnosis. 2005–2006;48:153–161.

Dinges DF, Whitehouse WG, Orne EC, Bloom PB, Carlin MM, Bauer NK, et al. Self-hypnosis training as an adjunctive treatment in the management of pain associated with sickle cell disease. International Journal of Clinical and Experimental Hypnosis. 1997;45:417–432.

Edelson J, Fitzpatrick JL. A comparison of cognitive-behavioral and hypnotic treatments of chronic pain. Journal of Clinical Psychology. 1989;45:316–323.

Gay M, Philippot P, Luminet O. Differential effectiveness of psychological interventions for reducing osteoarthritis pain: A comparison of Erikson hypnosis and Jacobson relaxation. European Journal of Pain. 2002;6:1–16.

Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, et al. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. Journal of Rheumatology. 1991;18:72–75.

Jensen MP, Hanley MA, Engel JM, Romano JM, Barber JB, Cardenas DD, et al. Hypnotic analgesia for chronic pain in persons with disabilities: A case series. International Journal of Clinical and Experimental Hypnosis. 2005;53:198–228.

McCauley JD, Thelen MH, Frank RG, Willard RR, Callen KE. Hypnosis compared to relaxation in the outpatient management of chronic low back pain. Archives of Physical Medicine and Rehabilitation. 1983;64:548–552.

Melzack R, Perry C. Self-regulation of pain: The use of alpha-feedback and hypnotic training for the control of chronic pain. Experimental Neurology. 1975;46:452–469.

Simon EP, Lewis DM. Medical hypnosis for temporomandibular disorders: Treatment efficacy and medical utilization outcome. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2000;90:54–63.

Spiegel D, Bloom JR. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine. 1983;45:333–339.

The China Syndrome
One of the best investment opportunities in your lifetime.
By Gary Smith

China: I have beating the drum for 3 years about. It is happening now.  Question is do you want to be in on this great opportunity.
 
Let’s start with a little background recent history. Two years ago China was voted into the IMF (international Monetary Fund). There were only 5 countries in the IMF before this.  The IMF meets every 10 years.  They made an exception, but first China had to stop manipulating its currency.
 
What does this mean? China since June of 2018 was allowed to trade with other countries in the Yuan (the Chinese currency).  They artificially manipulated their currency so that trade with other countries would be more beneficial to them.  The IMF initially said this has to stop before they would be considered.  Ultimately, this means the Yuan will be a top international currency instead of the dollar. Your dollar will be less and less meaningful as when people travel and trade.  China has the ability to convert other currencies into the Yuan instead of the traditional dollar. More than 1 trillion dollars will move into China.
 
One year ago the MSCI voted to allow China into the this international fund.-  Many people have their money with financial managers.  The International MSCI fund previously did not invest in China because of their nefarious use of money. Now between 12-17 % of the MSCI international funds will be invested in China - that means 1-2 trillion dollars in the next 3-5 years will flow into China.
 
China has the 4-2-1 rule.   For the last generation parents were only allowed to have one child in China.  Traditionally the children take care of the parents and grandparents. Further, they were not allowed to invest in any stock market.  Their retirement money and investment money were put into low interest bearing accounts.  This prevented any significant growth.  The children were left to few dollars to care for their families.  Recently China has allowed investments into the Chinese stock market.  The expectation is that in the next 2-3 years another 1-2 trillion dollars will flow into Chinese investments from within the country.
 
Lastly, the Chinese just started a new stock market called the New Nasdaq.  It just opened for investment last week.  In the first day the market went up 140 %.  There are only 10 or so stocks in this market at this time.  Why the new market you might ask?  Really very simple.  China wants to overtake the world in Technology. They have the capacity, the money, the power to make it happen.  Universities are hiring Chinese Post Docs in all technology fields including biomedical engineering, nanotechnology, AI(which China is close to leading the world in) and represents the next frontier in growth tech and biotech. China is building new cities with ultramodern structures and environmentally friendly Technology.   I hope to address this in the next article.
 
I can go on and on about China but just this article alone expressed the investment the world has yet to appreciate about China. It is not to late to invest in China.
 
In summary in the next 3-5 years over 6 trillion dollars will flow into China.  As America heads into recession or worse China may be the frontier to be invested in. This is a compelling argument but like any other investment there is certainly a chance this will not pan out. Discuss these options seriously with your money manager and consider pushing the envelope with them. 
 
If you want to know more about China please email me at gsmith@fjmc.org. Research for this article has been on going with bibliography from Stansberry, Peter Churchill, Witney Tilson, and Zacs, etc.