Attacks may be more frequent from midnight to 3 AM due to normal circadian rhythms. (Rossi, 1986, p. 166)
Maybe associated to dependency issues, particularly related to struggles for independence from maternal influence. (Epstein, p. 65)
Severity of asthma attack is directly related to the amount of fear and anxiety felt by the patient. Anxiety causes further bronchoconstriction. Therapy should be directed to reducing anxiety. (Locke, 1986 p. 3)
Childhood asthma may have an important role in maintaining family homeostasis. Since recovery of the child would endanger the family's security, intrafamilial forces are inhibiting the child's recovery and play a role in the precipitation of the asthmatic attacks. Furthermore, many emotional conflicts between the parents and siblings often get avoided or diffused due to everyone's overriding concern over the asthma situation. The patient may serve as a "conflict avoidance tool" and a protection for other family members and their submerged problems of functioning well as a unit. (Locke, 1986, p. 10, 52)
Mothers of asthmatics suffered more depressive illness than controls. (Locke, 1983, p. 132)
Fear of estrangement from mother and inhibition of crying may play etiologic roles. Such emotional factors and allergic factors complement each other in precipitating asthmatic attacks. (Locke, 1986, p. 44)
Asthmatics are often highly sensitive to the loss of love and appreciation from meaningful figures. This hypersensitivity is generally associated with strong feelings of dependency and compliance, which may alternate with unregulated expression of anger. (Locke, 1986, p. 53)
A 15 item MMPI (Minnesota Multiphasic Personality Inventory) scale has been developed that relates to the reported frequency of panic-fear symptoms on the Asthma Symptom Checklist (ASC). High scales scores describe fearful, emotionally labile individuals who profess to be more sensitive than others, and are unable or disinclined to persist in the face of difficulty. (Locke, 1983, p. 133)
Anxiety in asthma exists as two separate types of anxiety, with different implications in treatment prognoses. MMPI Panic-Fear scale is a measure of general, non-illness specific anxiety (or trait anxiety, a characterological and pervasive anxiety, or lack of basic ego resources); and the Panic-Fear symptom scale of the ASC is a measure of asthma-specific anxiety focused on the anxiety attack. Unusually high or low panic-fear personality styles are maladaptive; the former characterized by anxious, helpless dependency, and the latter by extreme counterphobic independence. When high characterological anxiety coexisted with high asthma-specific anxiety, medical outcome following intensive long-term medical and psychotherapeutic treatment was exceptionally poor. In contrast, when high asthma-specific anxiety coexisted with average levels of characterological anxiety, medical outcome was exceptionally good. (Locke, 1983, p. 134, 136, 137)
155 hospitalized asthma patients in 1976 were administered the MMPI in order to evaluate the existence of common personality characteristics. Findings refute any stereotypic asthmatic personality. The single most frequent pattern observed was a 'neurotic triad,' which is also characteristic of other chronic illnesses and seems to represent a defensive stance in coping. It appears more profitable to investigate individual personality patterns associated with coping styles and their relationship to the illness via behaviors that either maintain or delimit the effects of chronic asthma. (Locke, 1983, p. 136)
Child's repressed aggressiveness within the family and pathological fixation on mother.
Repression of the feelings of longing for more affection, fear of losing the mother, and anger at the deprivation experienced and expected. (Locke, 1986, p. 46, 54)
Cry for mother's love. (Locke, 1986, p. 49)
Bronchospasm in children may be brought on by crying. (Locke, 1986, p. 2)
Theories of initiation refer to the immediate post-nasal breathing pattern of an infant, whose first gasps of air are exhaled against upper respiratory tract resistance without effective contraction of the vocal cords, giving rise to the 'unvoiced' birth cry. It is noted that this innate reflex behavior is associated with pulmonary capillary dilation and the affects of fear, anger, and depression which may be associated with birth. (Locke, 1983, p. 138)
There is some "the chicken or the egg" controversy on emotional aspects of asthma; some say pathologic emotions are an etiology while others say they are secondary to the disease. (Locke, 1986, p. 48)
Fear of life; not wanting to be here. (Hay, 1988, p. 15)
Fear of maternal separation. (Alexander, p. 244)
Generalized fear, anger, and anxiety. (Alexander, p. 243)
Personality Traits: marked egocentricity, impulsive behavior, impatience, domineering, inflexibility, stubbornness, need for love and affection, jealousy, late bloomers. (Jores, p. 286)
Dependency was not found to be associated with the severity of asthma, but was associated with family relationship patterns in a study of 60 children which questioned whether childhood asthma produced increased dependency. (Locke, 1983, p. 138)
Asthma patients feel unloved, left out, or ignored, and wants to screen out another individual or situation. (Gentry, p. 43)
Associated with disturbance in attitude including attitude toward father, heterosexual relationships, and own abilities. (Locke, 1983, p. 131)
The arrival of a new family member, or a period of 0-3 years in marriage, were connected with insidious asthma most frequently. (Locke, 1983, p. 142)
Asthmatics are intelligent but inhibited. They have covert aggression, neurotic construction and marked affectional and dependency needs. They have excessive dependency on mother and sexual disturbance. They have considerable anxiety, irrational fears, guilt feelings, and insecurity. When high goals were set, they were unable to achieve them. (Locke, 1983, p. 139)
Among the psychic factors, introversion in particular is probably important in the combination of factors affecting the inception of asthma. (Locke, 1983, p. 141)
Poor psychosocial adaptation, obsessive neurosis, immature personality, and alcohol problems are associated with static or deteriorating trends in asthma. The patients who were the most extroverted and/or lacked psychic symptoms almost always fell into the group with favorable prognoses. (Locke, 1983, p. 141)
Individual feels left out, unloved or ignored, and wants to screen out another individual or the situation, and not have anything to do with them. (Gentry, p. 43)
Psychotherapy in asthma-prurigo syndrome in children: in all cases the asthma responded sooner than the eczema. (Locke, 1986, p.77)
Children with asthma/enuresis appear to be at high risk for lower levels of self-esteem, poor quality of life in the past year, self-complexity, and parental preference for their siblings. (Locke, 1983, p. 138)
Chinese psychophysiology:
Lung ~ Fei is the home of the Po (Corporeal Soul); governs the Qi; facilitates the immune function by assisting the dispersal of the Wei (Protective) Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; relates to strength and sustainability; moves and adjusts fluid metabolism; extends through the skin, controls the pores, and manifests through the body hair.
» Healthy expressions are righteousness and courage.
» Weakness, dysfunction, and illness are associated with excessive grief, sadness, worry, and depression. Worry depletes the Lung Qi.
» Lung Xu (Deficiency) signs include cold shoulder and back; changing complexion; inability to sleep (Seem, p. 28); shortness of breath; changes in urine color; rumbling in the bowels with loose bowel movements; pallor; malar flush; chills; sniffles; sneezing; light cough; and sensitivity to cold.
Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; maintains smooth flow of Qi; controls the muscles, especially their contractility; and reflects emotional harmony and movement.
» Healthy expressions are kindness, spontaneity, and ease of movement.
» Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry skin and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down.
» Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Liver Shi (Excess) can produce Liver Fire which often will "insult" the Lung causing constriction and a dry, teasing cough.
Spleen ~ Pi governs digestion and manifests in the muscle tissues; resolves Dampness and Phlegm; maintains upbearing; and relates to the ability to assimilate, stabilize, and feel balanced and centered.
» Healthy expressions are fairness, openness, deep thinking, and reminiscence.
» Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; easy bruising; pale lips; loose stools; muscular weakness; and, indirectly, obesity.
» The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and/or Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.
Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; facilitates inspiration by grasping and pulling down the Qi of the breath; relates particularly to chronic conditions because it carries the constitutional endowment from the parents; and and displays the effects of aging, overwork, chronic degenerative processes and extreme stress.
» Healthy expressions are gentleness, groundedness, and endurance.
» Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch.
» Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).
therapies
behavior modification:
systematic desensitization: after relaxing patient, describe disturbing aspects of the disease ranging from mild asthma to death from status asthmaticus until patient no longer reacts with anxiety. Since anxiety exasperates the asthmatic condition, desensitization helps reduce attacks and their severity. (Locke, 1986, p. 39).
Biofeedback: Training both for facial muscle relaxation and for respiratory resistance decrease improves short term pulmonary function. Biofeedback mediated deep muscle relaxation procedures also produced significant results. (Locke, 1986, p. 9)
Combined biofeedback and counterconditioning deals directly with the acquired hypersensitivity of the airways and is more successful. Treatment involved instigation of bronchial constriction followed by training to substitute bronchial dilation when faced with previously conditioned stimuli through biofeedback reinforcement. Results showed decreased frequency of attacks, ER visits, and amount of medication. (Locke, 1986, p. 4, 69)
Demonstrate diaphragmatic breathing with patient hand on abdomen, as many asthmatics inhale with the diaphragm raised rather than relaxed. Instruct patient to "notice the feelings as the tubes open up." (Zahourek, p. 93)
Yoga: The integral yoga approach to asthma includes correction of distorted posture and faulty breathing habits, methods for the expectoration of mucous, teaching a system of general muscle relaxation, techniques for the release of suppressed emotion and for reducing anxiety and self conscious awareness. (Locke, 1986, p. 27)
Yoga Research Institute in India summarized breathing exercises: The abdominal muscles and the diaphragm must both be used. The duration of exhalation must double that of inhalation. Resistance must be made to the free passage of air when breathing in and out, by contracting the larynx or pursing the lips. The patient must let his mind follow the process of exhalation, and the practitioner then follows some form of progressive or dynamic relaxation. (Locke, p. 66)
Muscular relaxation therapy alone appears to have no effect. Certain relaxation techniques, such as autogenic training, transcendental meditation, systematic desensitization, and biofeedback-assisted relaxation can produce improvement. (Locke, 1986, p. 67)
imagery:
Explain what bronchi look like, have patient experience that attack can be made worse by seeing bronchi tighten, patient discovers he has control, and can make it worsen or lessen. (Bry, p. 23)
Imagine yourself in a leaf, being the breathing process of the leaf. (Epstein, p. 65)
anti-allergen (Fanning, 270)
at the forge (Chavez)
chest treasure (Chavez)
open flow (Chavez)
steam whistle (Chavez)
related materia medica listings: imagery for anxiety and depression
affirmation:
It is safe for me to take charge of my own life.
I choose to be free. (Hay, 1988, p. 15)
journaling:
Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences demonstrated clinically relevant positive changes in health status beyond those attributable to the standard medical care that controls were also receiving. (Smyth J, et al. JAMA. 1999;281:1304-1309.)
theotherapy:
Ares, Eris, Odysseus, Medusa, Poseidon, Typhon, Tyro (Lemesurier, p. 88)
hypnotherapy:
Helps not only in treating asthma, but many of the ailments that accompany it (insomnia, nocturnal bronchospasm, migraine, atopic eczema, vasomotor rhinitis, hay fever - all these conditions share a common autonomic imbalance). Autohypnosis perpetuates the effect and makes the patient feel that he is contributing towards his own recovery, thus helping to restore confidence that the condition itself so often undermines. (Locke, 1986, p. 17)
Hypnosis should never be used to suppress the asthmatic attacks without thoroughly explaining the causation of the asthma. The asthmatic syndrome might very well be the visible manifestation of some will-hidden, deep-rooted psychosis, which if not handled properly could very well cause some much more serious symptom than asthma. Thorough understanding of this fact is vital. (Locke, 1986, p. 19)
Conditioning procedures involving reciprocal inhibition, altered perception associated with hypnosis, etc., are successful in greatly reducing or eliminating asthma in many subjects. (Locke, 1983, p. 138)
psychotherapy:
Group therapy for families with asthmatic child is beneficial. Removal of the child from the family environment is also successful, especially for the child with a large emotional overlay with the condition, and results for many in long-term benefit. (Locke, 1986, p. 31)
Most patients show suppressed depression or aggression. The majority improved markedly when the depression was relieved and/or the expression of anger was facilitated. (Locke, 1983, p. 138)
Asthmatics are trying to take too much, but when it comes to giving it back, there is constriction. Wherever tightness is detectable it is actually fear. The only way to fight fear is to expand. The following questions are given for asthmatics to consider:
» In which areas am I trying to take without giving?
» Can I admit consciously to my aggressive impulses? How can I express them?
» How am I coping with inner conflicts between dominance and submissiveness?
» Which areas of my life am I trying to avoid, and which do I regard as beneath me?
» Which areas of my life am I resisting and devaluing? Can I detect any fear that lies behind my system of personal values? (Dethlefsen, p. 122)
In the event of breath-related illness, the following questions may be asked:
» What is it that takes my breath away?
» What is it I am unwilling to accept? . . . to give out? . . . to come in contact with?
» Am I afraid to take a step towards some new freedom? (Dethlefsen, p. 122)
process paradigm: (experientially oriented)
What is the symptom preventing me from doing? What is the symptom making me do? (see process interview: respiratory system
related materia medica listings:
the shadow and physical symptoms
converting a signal to a symptom
subjective inquiry approach
behavior modification techniques (see also: biofeedback, systematic desensitization)
relaxation techniques (especially breathing)
healing power of meditation
imagery: precautions
imagery: techniques
affirmations: guidelines and precautions
theotherapy
hypnotherapy
process paradigm
footnotes
Smyth J, Stone A, Hurewitz A, Kaell A. Effects of Writing About Stressful Experiences on Symptom Reduction in Patients With Asthma or Rheumatoid Arthritis, A Randomized Trial. JAMA. 1999;281:1304-1309.
Abstract: Context Nonpharmacological treatments with little patient cost or risk are
useful supplements to pharmacotherapy in the treatment of patients with chronic illness. Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports, well-being, and health care use in healthy individuals. Objective To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using standardized quantitative outcome measures. Design Randomized controlled trial conducted between October 1996 and December 1997. Setting Outpatient community residents drawn from private and institutional practice. Patients Volunteer sample of 112 patients with asthma (n=61) or rheumatoid arthritis (n=51) received the intervention; 107 completed the study, 58 in the asthma group and 49 in the rheumatoid arthritis group. Intervention Patients were assigned to write either about the most stressful event of their lives (n=71; 39 asthma, 32 rheumatoid arthritis) or about emotionally neutral topics (n=41; 22 asthma, 19 rheumatoid arthritis) (the control intervention). Main Outcome Measures Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinically examined by a rheumatologist. Assessments were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition. Results Of evaluable patients 4 months after treatment, asthma patients in the experimental group showed improvements in lung function (the mean percentage of predicted forced expiratory volume in 1 second [FEV1] improved from 63.9% at baseline to 76.3% at the 4-month follow-up; P<.001), whereas control group patients showed no change. Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity (a mean reduction in disease severity from 1.65 to 1.19 [28%] on a scale of 0 [asymptomatic] to 4 [very severe] at the 4-month follow-up; P=.001), whereas control group patients did not change. Combining all completing patients, 33 (47.1%) of 70 experimental patients had clinically relevant improvement, whereas 9 (24.3%) of 37 control patients had improvement (P=.001). Conclusion Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group. These gains were beyond those attributable to the standard medical care that all participants were receiving. It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases.