Coping with a hypersensitive gag reflex can be a cause for concern for both the patient and the operator. This report describes a case of blood phobia directed solely towards the oral cavity, linked with the inability to tolerate dentures due to a hypersensitive gag reflex. Management by hypnotherapy using a systematic desensitization technique allowed for extraction of teeth and permanent elimination of the gagging problem.

Dent Update. 2002 Mar;29(2):70-4. Noble S. South Birmingham Community Hea lth NHS Trust.

This paper deals with the evolution of medicine from chemical medicine to energy medicine to information medicine as, first, standard electric, magnetic, and electromagnetic fields are applied to a patient and, second, as subtle energy fields are applied to the patient. Next, a brief reporting is given on our specific intention imprinting of a simple electrical device, which, when turned on in a given space, lifts the inner symmetry state of that space and tunes that space so that the specific intention, acting on the materials in that space, causes well-designed target experiments running in that space to yield results in full accord with the specific intention. A new theoretical model of nature is provided to explain these seemingly anomalous phenomena. A new perspective on what constitutes the whole person is also provided and one finds that human consciousness will become an important experimental variable in future medicine.

J Altern Complement Med. 2004 Oct;10(5):867-77. Tiller WA. William A. Tiller Foundation for New Science, 909 South Pinecone Street, Payson, AZ 85541-573, USA. bill@tiller.org

OBJECTIVES: To describe the extent to which chiropractors utilize standardized outcome and various clinical measures to systematically document patients' baseline health status and responses to treatment, with particular consideration being given towards quantifiable outcome instruments. STUDY DESIGN: Cross-sectional mailed survey. PARTICIPANTS: Registered chiropractors in the province of Saskatchewan. METHODS: A survey was mailed to all registrants of the Chiropractors' Association of Saskatchewan. Respondents graded their frequency of using various standardized pencil-and-paper instruments and functional chiropractic, orthopaedic and neurological tests in the contexts of both the initial intake assessment ('always,' 'commonly,' 'occasionally,' or 'never') and the course of subsequent treatment (after 'each visit,' after '9-12 visits,' 'annually,' when patient 'not responding,' on 'dismissal/discharge,' 'never' or for some 'other' reason). Data were tabulated for all item and response category combinations as frequencies and percentages using the total sample size as the denominator. RESULTS: Of 164 registered chiropractors, 62 (38%) returned a completed questionnaire. A pain diagram was the most commonly used subjective outcome measure and was administered routinely (either "always" or "commonly") by 75% of respondents, at either the initial consultation or during a subsequent visit. Numerical rating and visual analogue scales were less popular (routinely used by 59% and 42% respectively). The majority of respondents (80%) seldom ("occasionally" or "never") used spine pain-specific disability indices such as the Low Back Revised Oswestry, Neck Disability Index or the Roland-Morris Questionnaire. As well, they did not use standardized psychosocial instruments such as the Beck Depression Index, or general health assessment measures such as the SF-36 or SF-12 questionnaire. Neurological testing was the most commonly used objective outcome measure. Most respondents (84% to 95%) indicated that they continually monitored neurological status through dermatomal, manual muscle strength and deep tendon reflex testing. Ranges of motion were routinely measured by 95% of respondents, usually visually (96%) rather than goniometrically or by some other specialized device (7%). CONCLUSIONS: Our findings suggest that the majority of chiropractors do not use psychosocial questionnaires or condition-specific disability indices to document baseline or subsequent changes in health status. Chiropractors are more likely to rely on medical history taking and pain drawings during an initial intake assessment, as well as neurological and visually estimated range of motion testing during both initial intake and subsequent treatment visits.

Full Title: Qi Gong exercises and Feldenkrais method from the perspective of Gestalt concept and humanistic psychology

This study describes two similar approaches to human movement: Qi Gong exercises and the Feldenkrais method. These systems are investigated in terms of Gestalt concepts and humanistic psychology. Moshe Feldenkrais created the concept known as Awareness Through Movement. This concept assumes that by becoming more aware of one's movements, one functions at a higher level. In similar ways to those using the Feldenkrais method, individuals may become more aware of their own movements by performing Qi Gong exercises: A therapeutic modality that facilitates mind-body integration. Qi Gong exercises commonly lead to increased personal awareness accompained by enhanced quality, fluency and smoothness of movement. These two methods of movement therapies are explored in terms of their relations with Gestalt concept and humanistic psychology. (c) 2008. Published by Elsevier Ltd. All rights reserved.

J Bodyw Mov Ther. 2010 Jul;14(3):227-33. Epub 2009 Feb 1. Posadzki P, Stöckl A, Mucha D. School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK. p.posadzki@uea.ac.uk

Kinesiology is the study of human movement, and comprises several disciplines, each devoted to a specific aspect of human activity, each with its own set of principles and methods to assess and analyze movement. Forensic kinesiology is the application of kinesiological techniques to accident/crime investigation; specialists in this field can use various tools and procedures to measure, analyze, model, and determine the movement sequences involved in events under investigation. This article will highlight major subdisciplines of kinesiology most relevant to forensics, present the key assessment and analytical tools used by kinesiologists, and demonstrate how both the principles and the practices of kinesiology can be applied to accident/crime investigation.

Am J Forensic Med Pathol. 2010 Jun;31(2):200-3. Pelham TW, Holt LE, Holt J. School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada.

Dr. Bruce Goldberg holds a B.A. degree in Biology and Chemistry, is a Doctor of Dental Surgery from the University of Maryland (1974) School of Dentistry, and has a Masters degree in Counseling Psychology. He retired from dentistry in 1989, and since then has concentrated on his thriving international hypnotherapy practice in Los Angeles, California.

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Full Title: Back massage therapy promotes psychological relaxation and an increase in salivary chromogranin A release

Massage therapy promotes psychosocial relaxation, reduces stress and has been reported to improve the immune function. As such, massage therapy is currently used in palliative care for the relief of anxiety and pain. Although psychosocial status has been evaluated using subjective psychological tests, such as State-Trait Anxiety Inventory (STAI), subjective psychological tests are of limited value if the subjects fail to report reliably. Salivary biomarkers have been recently suggested as useful objective markers for assessing psychosocial status. To determine whether salivary biomarkers are useful objective indices for assessing the effects of back massage on the mental status of 25 young healthy female volunteers, we measured heart rate and salivary biomarkers (alpha-amylase activity, cortisol, and chromogranin A) and assessed the STAI score before and after the back massage. Back massage significantly reduced the heart rate and STAI; however, salivary amylase and cortisol levels did not change. In contrast, the level of salivary chromogranin A significantly increased. We therefore conclude that changes in the salivary biomarkers tested here may not indicate changes in psychological status following massage therapy. However, the increase in chromogranin A release may contribute to the immunologically beneficial effects of massage therapy as chromogranin A has antibacterial and antifungal activity.

J Anesth. 2010 Aug 5.Noto Y, Kudo M, Hirota K. Department of Nursing, Hirosaki University Graduate School of Health Sciences, Hirosaki, 036-8563, Japan.

by Mark Gorkin, LICSW

Keys to Strengthening Buy-in, Trust and Team Coordination in a Generationally-Culturally Diverse (Military) Workforce -- Part II

Part I of this two-part series has delineated five of the "Top Ten Tools and Strategies for Strengthening Buy-in, Trust and Team Coordination among a Generationally-Culturally Diverse (Military) Workforce," including building communication bridges and fostering a team/systems concept that has application for both military and non-military work settings.

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TOPIC: Ericksonian hypnosis conceptual framework. PURPOSE: To acquaint psychiatric-mental health nurses with hypnotic principles and how these can be integrated into their practice. SOURCES: Published literature and author's clinical experience. CONCLUSIONS: Ericksonian hypnosis offers an array of potential interventions for psychiatric-mental health nurses to integrate into their practices in a framework familiar to nurses: holism, honoring and respecting individuality, and capitalizing on an individual's strengths.

Perspect Psychiatr Care. 2002 Jan-Mar;38(1):15-22. Zahourek RP. New York University, Division of Nursing, New York, USA. rorryz@aol.com

Low heart rate variability (HRV) characterizes several medical and psychological diseases. HRV biofeedback is a newly developed approach that may have some use for treating the array of disorders in which HRV is relatively low. This review critically appraises evidence for the effectiveness of HRV and related biofeedback across 14 studies in improving (1) HRV and baroreflex outcomes and (2) clinical outcomes. Results revealed that HRV biofeedback consistently effectuates acute improvements during biofeedback practice, whereas the presence of short-term and long-term carry-over effects is less clear. Some evidence suggests HRV biofeedback may result in long-term carry-over effects on baroreflex gain, which is an area most promising for future investigations. On the other hand, concerning clinical outcomes, there is ample evidence attesting to efficacy of HRV biofeedback. However, because clinical and physiological outcomes do not improve concurrently in all cases, the mechanism by which HRV biofeedback results in salutary effects in unclear. Considerations for the field in addressing shortcomings of the reviewed studies and advancing understanding of the way in which HRV biofeedback may improve physiological and clinical outcomes are offered in light of the reviewed evidence.

Appl Psychophysiol Biofeedback. 2010 Sep;35(3):229-42. Wheat AL, Larkin KT. Psychology Department, West Virginia University, 53 Campus Drive, 1124 Life Sciences Building, Morgantown, WV 26506-6040, USA. Amanda.wheat@mail.wvu.edu

Full Title: The relationship between patient and practitioner expectations and preferences and clinical outcomes in a trial of exercise and acupuncture for knee osteoarthritis

We investigated the relationship between patient and therapist preferences and expectations and clinical outcomes in a trial of exercise and acupuncture for clinical knee osteoarthritis. 352 Patients were randomised to advice and exercise or advice and exercise plus true or non-penetrating acupuncture. Before randomisation, patients recorded their general outcome expectations, treatment-specific preferences and expectations. Clinical outcome was (a) change scores on the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and (b) treatment response according to the OMERACT-OARSI criteria. Physiotherapists recorded their treatment expectations and preferences for each patient following an assessment prior to randomisation. We investigated the relationship between (a) patient, (b) therapist and (c) matched patient-therapist preferences and expectations on clinical outcomes using univariate and multivariate analyses. There was no significant relationship between patients' treatment preferences and clinical outcomes at 6 or 12months nor between patients' expectations and pain (WOMAC) at 6 or 12months. Using our secondary outcome (OMERART-OARSI), those who received the treatment for which they had high expectations of benefit were almost twice as likely to be classified as a treatment responder at 6months (odds ratio (OR) 1.7 (95% Confidence Interval 1.06, 2.79)) and 12months (OR) 1.9 (1.13, 3.13). Therapists' preferences and expectations for individual patients did not add further explanation of outcomes. There was no evidence of a relationship between patients' treatment preferences or expectations and pain reduction. We found weak evidence, from secondary outcomes, that patients' expectations, both general and treatment-specific, are related to clinical outcome from exercise and acupuncture.

Eur J Pain. 2009 Aug 6. Foster NE, Thomas E, Hill JC, Hay EM. Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.

Shealy Healy has been a life coach (yoga/fitness and spiritual advocate) for over twenty-five years. She is known for making accurate analysis of your present life circumstances and predictions of your future-health, wealth and happiness-based upon your core beliefs and behaviors.

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Pruritus, or generalized itch, is a source of serious discomfort and distress in a significant minority of people living with AIDS. Anecdotal reports suggest hypnosis might be a useful treatment, leading to reductions in distress and improvements in the condition. But empirical examination of the question is notably lacking. This time-series study reports results of a 6-session self-hypnosis treatment (relaxation, deepening, imagery, and home practice) for 3 HIV-positive men suffering from pruritus, related to disease progression and/or HIV medications. Posttreatment, all 3 patients reported significant reductions in daily itch severity and extent of sleep disturbance due to itch. One patient also evidenced significantly less itch distress. Another also experienced significantly less time bothered by itch. For the 2 patients on which 4-month follow-up data were available, treatment benefit across variables was stable or further improved.

Int J Clin Exp Hypn. 2002 Apr;50(2):149-69. Rucklidge JJ, Saunders D. The Toronto Hospital, Canada. j.rucklidge@psyc.canterbury.ac.nz

Numerous treatment modalities for decompensated tinnitus incorporate psychological principles. Procedures of energy psychology and thought field therapy are introduced in two case studies. Data were collected from psychotherapy sessions and psychological tests. Two case studies demonstrated that thought field therapy reduces symptoms of depression and anxiety in decompensated tinnitus patients. The methods of thought field therapy can be taught to non-mental health professionals. Audiologists and psychotherapists should collaborate to develop more efficacious treatments.

Int Tinnitus J. 2009;15(2):130-3. Pasahow RJ. Affiliates in Psychotherapy, Northfield, New Jersey 08225, USA. affiliates600@aol.com

by Alfred A Barrios, PhD

The question of whether man does or does not have free will has been debated down through the centuries by some of the greatest minds but has never been fully answered. There are those, call them idealists, who say that of course we have free will; we can control our own destiny; we can choose between misery and happiness. Then there are the realists who point to all the miserable people in the world and ask did all these people freely choose to be miserable?

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BACKGROUND: Some chiropractors and their associations claim that chiropractic is effective for conditions that lack sound supporting evidence or scientific rationale. This study therefore sought to determine the frequency of World Wide Web claims of chiropractors and their associations to treat, asthma, headache/migraine, infant colic, colic, ear infection/earache/otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence). METHODS: A review of 200 chiropractor websites and 9 chiropractic associations' World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States was conducted between 1 October 2008 and 26 November 2008. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment. RESULTS: We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain, CONCLUSIONS: The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.

Full Title: Cognitive behavioral therapy for depression among adults in Japanese clinical settings: a single-group study

ABSTRACT: BACKGROUND: Empirical support for cognitive behavioral therapy (CBT) for treating Japanese patients with major depression is lacking, therefore, a feasibility study of CBT for depression in Japanese clinical settings is urgently required. FINDINGS: A culturally adapted, 16-week manualized individual CBT program for Japanese patients with major depressive disorder was developed. A total of 27 patients with major depression were enrolled in a single-group study with the purpose of testing the feasibility of the program. Twenty six patients (96%) completed the study. The mean total score on the Beck Depression Inventory-II (BDI-II) for all patients (Intention-to-treat sample) improved from 32.6 to 11.7, with a mean change of 20.8 (95% confidence interval: 17.0 to 24.8). Within-group effect size at the endpoint assessment was 2.64 (Cohen's d). Twenty-one patients (77.7%) showed treatment response and 17 patients (63.0%) achieved remission at the end of the program. Significant improvement was observed in measurement of subjective and objective depression severity (assessed by BDI-II, Quick Inventory of Depressive Symptomatology-Self Rated, and Hamilton Depression Rating Scale), dysfunctional attitude (assessed by Dysfunctional Attitude Scale), global functioning (assessed by Global Assessment of Functioning of DSM-IV) and subjective well-being (assessed by WHO Subjective Well-being Inventory) (all p values < 0.001). CONCLUSIONS: Our manualized treatment comprised of a 16-week individual CBT program for major depression appears feasible and may achieve favorable treatment outcomes among Japanese patients with major depression. Further research involving a larger sample in a randomized, controlled trial design is warranted. TRIAL REGISTRATION: UMIN-CTR UMIN000002542.

BMC Res Notes. 2010 Jun 7;3:160. Fujisawa D, Nakagawa A, Tajima M, Sado M, Kikuchi T, Hanaoka M, Ono Y. Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan. dai_fujisawa@yahoo.co.jp.