"E-Therapy" Raises Questions, Possibilities

Therapy in cyberspace? It sounds like something out of Aldous Huxley's futuristic novel, Brave New World. Yet both service providers and recipients are already using the Internet as a tool in the delivery of treatment services for mental and addictive disorders.

How does "e-therapy" work? What are its limitations? And is it useful? Continuing Education for MFT
SAMHSA's Center for Substance Abuse Treatment (CSAT) sponsored a meeting last year to explore some of these questions and to launch a dialogue on this recent innovation.

In his opening remarks, CSAT Director H. Westley Clark, M.D., J.D., M.P.H., identified the most fundamental issue: What is e-therapy? He noted, "We currently have no solid definition for this new mode of treatment."

David Nickelson, Psy.D., J.D., Director of the Office of Technology Policy and Projects for the American Psychological Association, suggested that in order to define e-therapy, several questions would need to be answered: Is it traditional psychotherapy using a new medium? Or is it actually a new type of therapy? Should it be considered something other than therapy, such as counseling?

He identified some questions pertaining to health service as well, such as:

How do ethical and legal guidelines apply to e-therapy?

Should e-therapy be regulated?

Can e-therapy sessions be kept private and confidential?

Is it clinically appropriate to use the Internet in this way?

Advantages/Disadvantages
Gary Walz, Executive Director of the ERIC Counseling and Student Services Clearinghouse at the University of North Carolina-Greensboro, said that people who are in the midst of a serious crisis are not good candidates for e-therapy. This includes people who are suicidal or are experiencing a serious drug addiction.

Mr. Walz further noted that some clients might feel uncomfortable discussing important subjects online, and that the lack of immediacy and nonverbal cues could be a disadvantage. He also observed that no state licensor codes deal with e-therapy, no legislation guides its use, and many professional liability insurance policies will not cover it.

Dr. Nickelson added that some pathologies might present problems to treatment online. For example, when individuals are online, they can alter their identities and claim to be a different age or gender. This could be particularly problematic in the treatment of people with certain personality disorders, he said.

Several participants expressed concern about establishing rapport between client and therapist-often considered vital to successful therapy-over the Internet.

But participants also discussed the potential advantages that e-therapy offers. Mr. Walz noted that therapy online could help reach underserved populations, including those in remote geographical regions. Also, counselors could continue to treat clients who relocate to other areas. Clients with time constraints or difficult schedules might find e-therapy more convenient, he said. All of these factors could enable many more people to receive treatment then receive it currently.

Guidelines and Standards
Professional organizations are developing professional guidelines and standards for addressing practices that are unique to Internet counseling. Doug Gilbert, Ph.D., NCC, ethics officer for the National Board of Certified Counselors, discussed his organization's process for developing standards. These standards address such issues as verifying the identity of the Internet client, determining if a client is a minor and therefore in need of parental or guardian consent, and explaining to clients the procedures for contacting an Internet counselor offline.

Donna Ford, NCC, LPC, Past President of the American Counseling Association, recommended that counselors provide individual online counseling only through a secure Web site or e-mail application that uses appropriate security measures including encryption. Even so, she said, clients should be informed that some information transmitted may not be secure. Client waivers should acknowledge the understanding of the limitations in ensuring confidentiality of information. She added that counselors should identify potential situations to clients in which confidentiality would have to be breached.

Volunteer: Popular New Year's Resolutions

Have an idea for a service project – like getting a group together to volunteer each week at a homeless shelter, or reading to kids at your local library? Learn how to turn your volunteer idea into a successful service project using our do-it-yourself toolkits below.

Education
Help close the achievement gap and reduce “summer learning loss” by reading with kids or organizing a book drive.

•Toolkit: Read with Children
Read with Children: The Facts
Children who are not engaged in learning between school years suffer from “summer learning loss.” Many of the achievement gaps that continue to exist for disadvantaged students today result not from students falling behind during the school year but rather losing out on chances to learn over the summer.

Did you know that if a young person reads only five books over the summer, the effect “is potentially large enough to prevent a decline in reading achievement scores from the spring to the fall?” footnote 1

Did you know that if a young person is read to at least three times a week, that person is twice as likely to score in the top 25% of reading? footnote 2

Commit yourself and a team of your friends, family, and neighbors to help young people close the summer learning gap by joining United We Serve. This tool kit will give you the basics to start a reading program from scratch, recruit a team, organize your group, and make an impact.

•Toolkit: Organize a Book Drive | en Español
Starting a Book Distribution Team: The Facts
80% of preschool and after-school programs serving low-income populations have no age-appropriate books for their children. footnote 1

A recent study shows that while in middle-income neighborhoods the ratio of age-appropriate books per child is 13 to 1, in low-income neighborhoods the ratio is 1 for every 300 children. footnote 2

The most successful way to improve the reading achievement of low-income children is to increase their access to print. Communities ranking high in achievement tests have several factors in common: an abundance of books in public libraries, easy access to books in the community at large and a large number of textbooks per student. footnote 3

Commit yourself and a team of your friends and neighbors to help increase reading achievement and literacy by joining United We Serve. This tool kit will give you the basics to run a book drive, organize your group, and make an impact.

What will you do to help increase reading and literacy?


Health
Promoting healthy lifestyles in your community is key to preventing costly disease and improving our nation's health.

•Toolkit: Support Community Gardens | en Español
•Toolkit: Starting a Walking Team | en Español
•Toolkit: Promote Back to School Health | en Español
Community Renewal
At a time when many Americans are struggling with the loss of their job or their home, you can help meet some of their most basic needs by working to reduce hunger, secure donated clothing and strengthen community resources.

•Toolkit: Support Local Food Banks | en Español
•Toolkit: Organize a Clothing Drive | en Español
Energy and Environment
Join your friends and neighbors to reduce energy by auditing your home and helping maintain public lands.

•Toolkit: Audit Your Home | en Español
•Toolkit: Maintain Public Lands | en Español
•Toolkit: Let's Glean! (USDA)
Veterans and Military Families
Support military families and veterans who have served our country.

•Toolkit: Connecting Veterans to Community Services
Disaster Preparedness
Help your community prepare for disasters.

•Toolkit: Preparing Your Community for Disasters
Create Your Own Project
Work with your neighbors to identify local needs and find solutions that work. MFT Continuing Education
•Toolkit: Create Your Own Project
Disclaimer of Endorsement
Toolkit references to any specific non-profit organization, commercial product, process, or service by trade name, trademark, manufacturer, or otherwise do not necessarily constitute or imply its endorsement, recommendation, or favoring by the U.S. Government or any agency thereof.

Weight Loss: Popular New Year's Resolutions

Weight Loss for Life

■Can I benefit from weight loss?
■How can I lose weight?
■Your Plan for Healthy Eating
■Your Plan for Regular Physical Activity
■What types of weight-loss programs are available?
■Nonclinical Program
■Clinical Program
■Additional Reading
■Other Resources

--------------------------------------------------------------------------------

Weight Loss for Life There are many ways to lose weight, but it is not always easy to keep the weight off. The key to successful weight loss is making changes in your eating and physical activity habits that you can keep up for the rest of your life. The information presented here may help put you on the road to healthy habits. MFT Continuing Education

--------------------------------------------------------------------------------

Can I benefit from weight loss?
Some Weight-related Health Problems

■diabetes
■heart disease or stroke
■high blood pressure
■high cholesterol
■gallbladder disease
■some types of cancer
■osteoarthritis (wearing away of the joints)
■sleep apnea (interrupted
breathing during sleep)

Health experts agree that you may gain health benefits from even a small weight loss if:


■You are considered obese based on your body mass index (BMI) (see BMI chart below).
■You are considered overweight based on your BMI and have weight-related health problems or a family history of such problems.
■You have a waist that measures more than 40 inches if you are a man or more than 35 inches if you are a woman.
A weight loss of 5 to 7 percent of body weight may improve your health and quality of life, and it may prevent weight-related health problems, like type 2 diabetes. For a person who weighs 200 pounds, this means losing 10 to 14 pounds.

Even if you do not need to lose weight, you should still follow healthy eating and physical activity habits to help prevent weight gain and keep you healthy over the years.

Body Mass Index

BMI is a tool that is often used to determine whether a person’s health is at risk due to his or her weight. It is a ratio of your weight to your height. A BMI of 18.5 to 24.9 is considered healthy, a BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or more is considered obese. You can find your BMI using the chart below, and you can also see the weight range that is healthy for your height.

BMI
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Weight
(Pounds)
Height (Inches)
58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255
68 125 131 138 144 151 158 164 171 177 184 190 197 204 210 216 223 230 236 243 249 256 262
69 128 135 142 149 155 162 169 176 182 189 196 203 210 216 223 230 236 243 250 257 263 270
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328


Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, National Institutes of Health, National Heart, Lung, and Blood Institute, September 1998.

* Without Shoes
**Without Clothes

--------------------------------------------------------------------------------

How can I lose weight? To lose weight you need to take in fewer calories than you use. You can do this by creating and following a plan for healthy eating and a plan for regular physical activity.

You may also choose to follow a formal weight-loss program that can help you make lifelong changes in your eating and physical activity habits. See below for more information on weight-loss programs.
--------------------------------------------------------------------------------

Your Plan for Healthy Eating
The Nutrition Facts label from the U.S. Food and Drug Administration (FDA) is found on most packaged foods. It tells you how many calories and how much fat, protein, carbohydrate, and other nutrients are in one serving of the food. For more information on the Nutrition Facts, see “Other Resources” at the end of this brochure.
It may be hard to stick to a weight-loss “diet” that limits your portions to very small sizes or excludes certain foods. You may have difficulty making that work over the long term. Instead, a healthy eating plan takes into account your likes and dislikes, and includes a variety of foods that give you enough calories and nutrients for good health.


Make sure your healthy eating plan is one that:

■Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
■Includes lean meats, poultry, fish, bean, eggs, and nuts.
■Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
For more specific information about food groups and nutrition values, visit: http://www.healthierus.gov/dietaryguidelines.

--------------------------------------------------------------------------------

Your Plan for Regular Physical Activity Regular physical activity may help you lose weight and keep it off. It may also improve your energy level and mood, and lower your risk for developing heart disease, diabetes, and some cancers.

According to the 2008 Physical Activity Guidelines for Americans, experts believe all adults should be physically active. Some activity is better than none, and individuals who engage in any amount of physical activity may gain some health benefits. The majority of your physical activity should be moderate to vigorous in intensity. However, adults should aim to include muscle-strengthening activities as well. For more information on the Physical Activity Guidelines, see the “Other Resources” section at the end of this brochure.

You can be physically active every day for one extended period of time, or you can break it up into shorter sessions of 20, 15, or even 10 minutes. Try some of these physical activities:


■walking (15 minutes per mile or 4 miles per hour)
■biking
■tennis
■aerobic exercise classes (step aerobics, kick boxing, dancing)
■energetic house or yard work (gardening, raking, mopping, vacuuming)
--------------------------------------------------------------------------------


What types of weight-loss programs are available? There are two different types of weight-loss programs—clinical and nonclinical. Knowing what a good program will offer and what to look for may help you choose a weight-loss program that will work for you.

Nonclinical Program

What it is: A nonclinical program may be commercially operated, such as a privately owned weight-loss chain. You can follow a nonclinical program on your own by using a counselor, book, website, or weight-loss product. You can also join others in a support group, worksite program, or community-based program. Nonclinical weight-loss programs may require you to use the program’s foods or supplements.

A safe and effective program will offer:

■Books, pamphlets, and websites that are written or reviewed by a licensed health professional such as a medical doctor (M.D.) or registered dietitian (R.D.).
■Balanced information about following a healthy eating plan and getting regular physical activity.
■Leaders or counselors who show you their training credentials. (Program leaders or counselors may not be licensed health professionals.)

Program cautions:

■If a program requires you to buy prepackaged meals, find out how much the meals will cost—they may be expensive. Also, eating prepackaged meals does not let you learn the food selection and cooking skills you will need to maintain weight loss over the long term.
■Avoid any diet that suggests you eat a certain formula, food, or combination of foods for easy weight loss. Some of these diets may work in the short term because they are low in calories. But they may not give you all the nutrients your body needs and they do not teach healthy eating habits.
■Avoid programs that do not include a physical activity plan.
■Talk to your health care provider before using any weight-loss product, such as a supplement, herb, or over-the-counter medication.
Clinical Program

What it is: A clinical program provides services in a health care setting, such as a hospital. One or more licensed health professionals, such as medical doctors, nurses, registered dietitians, and psychologists, provide care. A clinical program may or may not be commercially owned.

Clinical programs may offer services such as nutrition education, physical activity, and behavior change therapy. Some programs offer prescription weight-loss drugs or gastrointestinal surgery.

Prescription Weight-loss Drugs. If your BMI is 30 or more, or your BMI is 27 or more and you have weight-related health problems, you may consider using prescription weight-loss drugs. Drugs should be used as part of an overall program that includes long-term changes in eating and physical activity habits. Only a licensed health care provider can prescribe these drugs. See “Additional Reading” for more information about prescription medications for the treatment of obesity.

Bariatric Surgery. If your BMI is 40 or more, or your BMI is 35 or more and you have weight-related health problems such as diabetes or heart disease, you may consider bariatric surgery (also called gastrointestinal surgery). Most patients lose weight quickly. To keep the weight off, most will need to eat healthy and get regular physical activity over the long term. Surgery may also reduce the amount of vitamins and minerals that are absorbed by your body. The rapid weight loss as a result of bariatric surgery may also cause gallstones. See the “Additional Reading” section for more information about bariatric surgery.

What a safe and effective program will offer:

■A team of licensed health professionals.
■A plan to help you keep weight off after you have lost it.
Program cautions:

There may be side effects or health risks involved in the program that can be serious. Discuss these with your health care provider.

Regardless of the type of weight-loss program you choose, be sure you have follow-up visits with your health care provider. He or she may suggest ways to deal with setbacks or obstacles you may face along the way, as well as answer any questions you may have as you move forward.

For more detailed information about choosing a safe and successful weight-loss program, see the “Additional Reading” section at the end of this brochure.

It is not always easy to change your eating and physical activity habits. You may have setbacks along the way. But keep trying–you can do it!
Top


--------------------------------------------------------------------------------

Additional Reading
From the Weight-control Information Network Active at Any Size describes the benefits of being physically active no matter what a person’s size. The brochure presents a variety of activities that large people can enjoy safely.

Bariatric Surgery for Severe Obesity describes the different types of surgery available to treat severe obesity. It explains how gastrointestinal surgery promotes weight loss and the benefits and risks of each procedure.

Changing Your Habits: Steps to Better Health guides readers through steps that can help them determine what “stage” they are in—how ready they are—to make healthy lifestyle changes. Once that stage is determined, strategies on how to make healthy eating and physical activity changes are offered.

Just Enough for You describes the difference between a portion—the amount of food a person chooses to eat—and a measured serving. It offers tips for judging portion sizes and for controlling portions at home and when eating out.

Prescription Medications for the Treatment of Obesity presents information on medications that suppress appetite or reduce the body’s ability to absorb dietary fat. The types of medications and the risks and benefits of each are described.

Walking…A Step in the Right Direction offers tips for getting started on a walking program and illustrates warm-up stretching exercises. It also includes a sample walking program.

Weight and Waist Measurement explains two simple measures—BMI and waist circumference—to help people determine if their weight and/or body fat distribution are putting their health at risk.
Top


--------------------------------------------------------------------------------

Other Resources U.S. Department of Agriculture. My Pyramid Plan. April 2005.
Available at http://www.mypyramid.gov.

U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition. How to Understand and Use the Nutrition Facts Label. June 2000. Available at http://www.cfsan.fda.gov/~dms/foodlab.html.

U.S. Department of Health and Human Services (DHHS). Physical Activity Guidelines for Americans. October 2008. Available at http://www.health.gov/PAGuidelines.

National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH). Diabetes Prevention Program (DPP). DHHS. NIH Publication No. 09–5099. 2008.
Top


--------------------------------------------------------------------------------

Weight-control Information Network
1 WIN Way
Bethesda, MD 20892–3665
Phone: (202) 828–1025
FAX: (202) 828–1028
Toll-free number: 1–877–946–4627
Email: win@info.niddk.nih.gov
Internet: http://www.win.niddk.nih.gov

The Weight-control Information Network (WIN) is a national information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, which is the Federal Government’s lead agency responsible for biomedical research on nutrition and obesity. Authorized by Congress (Public Law 103–43), WIN provides the general public, health professionals, the media, and Congress with up-to-date, science-based health information on weight control, obesity, physical activity, and related nutritional issues.

Publications produced by WIN are reviewed by both NIDDK scientists and outside experts. This publication was also reviewed by F. Xavier Pi-Sunyer, M.D., M.P.H., Director, New York Obesity Research Center, St. Luke’s-Roosevelt Hospital Center, and English H. Gonzalez, M.D., M.P.H., Community Medicine and Curriculum Development Coordinator, St. Vincent’s East Family Medicine Residency Program in Birmingham, AL.

This publication is not copyrighted. WIN encourages users of this brochure to duplicate and distribute as many copies as desired.

Get Fit and Be Active Your Way: Popular New Year's Resolutions

Be Active Your Way
A Guide for Adults

•Wondering about how much activity you need each week?
•Want to get physically active but not sure where to begin?
•Already started a program and would like tips on how to keep it up or step it up?

Written for men and women ages 18 to 64, this booklet is based on the 2008 Physical Activity Guidelines for Americans released by the U.S. Department of Health and Human Services. When reading, you'll want to pay special attention to the Advice to Follow boxes in this booklet. They offer you a quick snapshot of the latest information from these new guidelines.

Share this booklet with your family and friends so you can be active together!

What is physical activity?
Did you know?

•Some activity is better than none.
•The more you do, the greater the health benefits and the better you’ll feel.
Physical activity is any form of exercise or movement of the body that uses energy. Some of your daily life activities—doing active chores around the house, yard work, walking the dog—are examples.

To get the health benefits of physical activity, include activities that make you breathe harder and make your heart and blood vessels healthier. These aerobic activities include things like brisk walking, running, dancing, swimming, and playing basketball. Also include strengthening activities to make your muscles stronger, like push-ups and lifting weights.

The good news?
People of all types, shapes, sizes, and abilities can benefit from being physically active. If you have a disability, choose activities in this booklet that work for you. Talk with your health care team about the amount and types of activities that are right for your ability or condition.

Making Physical Activity a Part of Your Life

Doing More
"I started taking a 45-minute water aerobics class with a group of women from church. It's really a lot of fun, and I am getting in shape. I started out going 2 days a week, and now my goal is to make it to all 3 classes a week."
Congratulations! You are doing some regular physical activity each week and are ready to do more. You may be feeling the benefits of getting active, such as having fun with friends, sleeping better, and getting toned. Are you looking for ways to do more activities at a moderate level?

Here are 2 examples for adding more activity
1.You can do more by being active longer each time. Walking for 30 minutes, 3 times a week? Go longer—walk for 50 minutes, 3 times a week.
2.You can do more, by being active more often. Are you biking lightly 3 days a week for 25 minutes each time? Increase the number of days you bike. Work up to riding 6 days a week for 25 minutes each time.
Tip: If you have not been this active in the past, work your way up. In time, replace some moderate activities with vigorous activities that take more effort. These are explained in detail in Part 3. Counselor Continuig Education
Activities for stronger muscles and bones
Advice to follow:
Adults should do activities to strengthen muscles and bones at least 2 days a week.
Choose activities that work all the different parts of the body—your legs, hips, back, chest, stomach, shoulders, and arms. Exercises for each muscle group should be repeated 8 to 12 times per session.

Try some of these activities a couple of days a week:
•Heavy gardening (digging, shoveling)
•Lifting weights
•Push-ups on the floor or against the wall
•Sit-ups
•Working with resistance bands (long, wide rubber strips that stretch)
Tip: Some people like resistance bands because they find them easy to use and put away when they are done. Others prefer weights; you can use common grocery items, such as bags of rice, vegetable or soup cans, or bottled water.

For best success
•Team up with a friend. It will keep you motivated and be more fun.
•Pick activities that you like to do.
•Track your time and progress. It helps you stay on course. Fill in these forms to help set your activity goals. Before you know it, you'll be able to do at least 2 hours and 30 minutes of activities at a moderate level each week.
•Add in more strength-building activities over time. For example, you can do sit-ups or push-ups.

Shaping up
"My son and I play in a baseball league twice a week. On the days we play, I sleep much better at night. This makes me want to do more on other days. My son wants to lift weights together, and so we got some weights and work out in the basement."

Planning your activity for the week
Physical activity experts say that spreading aerobic activity out over at least 3 days a week is best. Also, do each activity for at least 10 minutes at a time. There are many ways to fit in 2 hours and 30 minutes a week. For example, you can do 30 minutes of aerobic activity each day, for 5 days.

On the other 2 days, do activities to keep your muscles strong. Find ways that work well for you.

Want to learn more about how to add physical activity to your life?
•Join a fitness group.
•Talk to your health care provider about good activities to try.
•Speak to the worksite wellness coordinator at your job.
•Visit www.healthfinder.gov and type "activity" in the search box.

Managing Stress: Popular New Year's Resultions

Manage Stress

The Basics
Preventing and managing stress can help lower your risk of serious health problems like heart disease, high blood pressure, and depression. You can prevent or lessen stress by:

Planning ahead
Preparing for stressful events
Some stress is hard to avoid. You can find ways to manage stress by:

Noticing when you feel stressed
Taking time to relax
Getting active and eating healthy
Talking to friends and family
What are the signs of stress?
When people are under stress, they may feel:

Worried
Irritable
Depressed
Unable to focus
Stress also affects the body. Physical signs of stress include:

Headaches
Back pain
Problems sleeping
Upset stomach
Weight gain or loss
Tense muscles
Frequent or more serious colds
Use this tool to better understand your stress (http://www.mentalhealthamerica.net/llw/stressquiz.html).

What causes stress?
Stress is often caused by some type of change. Even positive changes, like marriage or a job promotion, can be stressful. Stress can be short-term or long‑term. LPC Continuing Education
Common causes of short-term stress:


Too much to do and not much time
Lots of little problems in the same day (like a traffic jam or running late)
Getting lost
Having an argument

Common causes of longer-term stress:


Divorce or problems in a marriage
Death of a loved one
Illness
Caring for someone who is sick
Problems at work
Money problems

What are the benefits of managing stress?
Managing stress can help you:

Sleep better
Control your weight
Get sick less often and heal faster
Lessen neck and back pain
Be in a better mood
Get along better with family and friends
Take Action!
Being prepared and in control of your situation will help you feel less stress. Follow these 9 tips for preventing and managing stress.

1. Plan your time.
Think ahead about how you are going to use your time. Write a to-do list and decide which tasks are the most important. Be realistic about how long each thing will take.

2. Prepare yourself.
Prepare ahead of time for stressful events like a job interview or a hard conversation with a loved one.

Picture the event in your mind.
Stay positive.
Imagine what the room will look like and what you will say.
Have a back-up plan.
3. Relax with deep breathing.
Find out how easy it is to use deep breathing to relax (http://www.helpguide.org/mental/stress_relief_meditation_yoga_relaxation.htm#deep).

4. Relax your muscles.
Stress causes tension in your muscles. Try stretching or taking a hot shower to help you relax. Check out these stretches you can do at your desk (http://dohs.ors.od.nih.gov/ergo_computers.htm#muscular).

5. Get active.
Physical activity can help prevent and manage stress. It can also help relax your muscles and improve your mood.

Aim for 2 hours and 30 minutes a week of moderate aerobic activity, like walking fast or biking.
Be sure to exercise for at least 10 minutes at a time.
Do strengthening activities (like sit-ups or lifting weights) at least 2 days a week.
6. Eat healthy.
Give your body plenty of energy by eating fruits, vegetables, and protein.

7. Drink alcohol only in moderation.
Don’t use alcohol and drugs to manage your stress. If you choose to drink, drink only in moderation. This means no more than 1 drink a day for women or 2 drinks a day for men.

8. Talk to friends and family.
Tell your friends and family if you are feeling stressed. They may be able to help.

9. Get help if you need it.
Stress is a normal part of life. But if your stress doesn’t go away or keeps getting worse, you may need help. Over time, stress can lead to serious problems like depression, post-traumatic stress disorder (PTSD), or anxiety.

If you are feeling down or hopeless, talk to a doctor about depression.
If you are feeling anxious, find out how to get help for anxiety (http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml).
A mental health professional (like a psychologist or social worker) can help treat these conditions with talk therapy (called psychotherapy) or medicines.

Lots of people need help dealing with stress – it’s nothing to be ashamed of!



Learn more about how you can keep your heart healthy.

Start Today: Small Steps
Find out how positive thinking can lower your stress (http://www.mayoclinic.com/health/positive-thinking/SR00009/METHOD=print).
Test your stress smarts (http://www.apa.org/helpcenter/stress-smarts.aspx).
Check out these tips for dealing with stress (http://familydoctor.org/online/famdocen/home/common/mentalhealth/stress/167.printerview.html).
You May Also Be Interested In
Content last updated on: December 20, 2010


National Health Information Center
P.O. Box 1133, Washington, DC 20013-1133
healthfinder@nhic.org

Popular New Year's Resolutions

Popular New Year's Resolutions
Check out some New Year's resolutions that are popular year after year.

•Drink Less Alcohol
•Get a Better Education
•Get a Better Job
•Get Fit
•Lose Weight
•Manage Debt
•Manage Stress
•Quit Smoking Now
•Save Money
•Take a Trip
•Volunteer to Help Others


Drink Less AlcoholSmall changes can make a big difference in reducing your chances of having alcohol-related problems. Here are some strategies to try. Check off some to try the first week, and add some others the next. MFT Continuing Education

Keeping Track
Keep track of how much you drink. Find a way that works for you, such as a 3x5” card in your wallet, check marks on a kitchen calendar, or a personal digital assistant. If you make note of each drink before you drink it, this will help you slow down when needed.

Counting and Measuring
Know the standard drink sizes so you can count your drinks accurately (see back page). One standard drink is 12 ounces of regular beer, 8 to 9 ounces of malt liquor, 5 ounces of table wine, or 1.5 ounces of 80–proof spirits. Measure drinks at home. Away from home, especially with mixed drinks, it can be hard to keep track and at times you may be getting more alcohol than you think. With wine, you may need to ask the host or server not to “top off” a partially filled glass.

Setting Goals
Decide how many days a week you want to drink and how many drinks you’ll have on those days. It’s a good idea to have some days when you don’t drink. Drinking within the limits below reduces the chances of having an alcohol use disorder and related health problems.


For healthy men up to age 65 —
•no more than 4 drinks in a day AND
•no more than 14 drinks in a week.
For healthy women (and healthy men over age 65) —
•no more than 3 drinks in a day AND
•no more than 7 drinks in a week.
Depending on your health status, your doctor may advise you to drink less or abstain.

Pacing and Spacing
When you do drink, pace yourself. Sip slowly. Have no more than one drink with alcohol per hour. Alternate “drink spacers” — non-alcoholic drinks such as water, soda, or juice — with drinks containing alcohol.

Including Food
Don’t drink on an empty stomach — have some food so the alcohol will be absorbed more slowly into your system.

Avoiding “Triggers”
What triggers your urge to drink? If certain people or places make you drink even when you don’t want to, try to avoid them. If certain activities, times of day, or feelings trigger the urge, plan what you’ll do instead of drinking. If drinking at home is a problem, keep little or no alcohol there.

Planning to Handle Urges
When an urge hits, consider these options: Remind yourself of your reasons for changing. Or talk it through with someone you trust. Or get involved with a healthy, distracting activity. Or “urge surf ”— instead of fighting the feeling, accept it and ride it out, knowing that it will soon crest like a wave and pass.

Knowing Your “No”
You’re likely to be offered a drink at times when you don’t want one. Have a polite, convincing “no, thanks” ready. The faster you can say no to these offers, the less likely you are to give in. If you hesitate, it allows time to think of excuses to go along.


Additional Tips for Quitting

--------------------------------------------------------------------------------

If you want to quit drinking altogether, the last three strategies can help. In addition, you may wish to ask for support from people who might be willing to help, such as a spouse or non-drinking friends. Joining Alcoholics Anonymous or another mutual support group is a way to acquire a network of friends who have found ways to live without alcohol. If you’re dependent on alcohol and decide to stop drinking completely, don’t go it alone. Sudden withdrawal from heavy drinking can cause dangerous side effects such as seizures. See a doctor to plan a safe recovery.



What’s a Standard Drink
In the United States, a standard drink is any drink that contains about 14 grams of pure alcohol (about 0.6 fluid ounces or 1.2 tablespoons). Below are U.S. standard drink equivalents. These are approximate, since different brands and types of beverages vary in their actual alcohol content.

beer or cooler
malt liquor
table wine
80-proof spirits
gin, vodka, whisky, etc.


˜ 5% alcohol:
12 oz.
˜ 7% alcohol:
8.5 oz.
˜ 12% alcohol:
5 oz.
˜ 40% alcohol:
1.5 oz.


Many people don’t know what counts as a standard drink and so don’t realize how many standard drinks are in the containers in which these drinks are often sold. Some examples:

For beer, the approximate number of standard drinks in
•12 oz. = 1
•22 oz. = 2
•16 oz. = 1.3
•40 oz. = 3.3
For malt liquor, the approximate number of standard drinks in
•12 oz. = 1.5
•22 oz. = 2.5
•16 oz. = 2
•40 oz. = 4.5
For table wine, the approximate number of standard drinks in
•a standard 750-mL (25-oz.) bottle = 5
For 80-proof spirits, or “hard liquor,” the approximate number of standard drinks in
•a mixed drink = 1 or more*
•a fifth (25 oz.) = 17
•a pint (16 oz.) = 11
•1.75 L (59 oz.) = 39
*Note: It can be difficult to estimate the number of standard drinks in a single mixed drink made with hard liquor. Depending on factors such as the type of spirits and the recipe, a mixed drink can contain from one to three or more standard drinks.


--------------------------------------------------------------------------------



Excerpted from NIH Publication No. 07–3769
Reprinted September 2008

FAA Certifies Santa’s NextGen-Equipped Sleigh for Christmas Eve

Press Release – FAA Certifies Santa’s NextGen-Equipped Sleigh for Christmas Eve
PrintEmailFor Immediate Release
December 20, 2010
Contact: FAA Press Office
Phone: 202-267-3883


--------------------------------------------------------------------------------

WASHINGTON – Federal Aviation Administration (FAA) safety inspectors at the North Pole certified Santa One, the reindeer-powered sleigh piloted by Santa Claus, for its Christmas Eve round-the-world delivery mission.

Santa One, led by Rudolph the Red-Nosed Reindeer, is outfitted with new satellite-based NextGen technology, which will allow Santa to deliver more toys to more children with improved safety and efficiency.

“Children around the world will get their gifts on time, regardless of the weather, thanks to NextGen,” said U.S. Transportation Secretary Ray LaHood. “We’re proud to say NextGen is bringing Santa Claus to town.”

Rudolph’s red nose has been outfitted with avionics that will broadcast Santa One’s position via satellites to air traffic controllers around the world with improved accuracy, integrity and reliability.

“Santa’s cockpit display will help improve his situational awareness by showing him and his reindeer flight crew their precise location in relation to other aircraft, bad weather and terrain,” said FAA Administrator Randy Babbitt. “NextGen will help make this an extra-safe Christmas Eve.”

The sleigh’s onboard systems have been upgraded with state-of-the-art, NextGen technology that will allow Santa One to maintain cruising altitude for as long as possible before making a continuous descent into cities and towns around the world. While maneuvering on rooftops, an advanced, onboard runway safety system will help reduce the risk of incursions between the sleigh and chimneys.

Santa’s reindeer-powered sleigh is already energy-efficient, but the NextGen technologies will further reduce Santa One’s carbon hoofprint. The shorter, faster routings means that Rudolph and the other reindeer will consume less hay, resulting in fewer greenhouse gases.

Unlike any other pilot, Santa has special permission from the FAA to fly thousands of domestic and international short-haul and long-range flights in one night. In keeping with the FAA's science-based proposal to give pilots more rest, Santa will arrange his flight plan based on his circadian rhythm. Mrs. Claus also assured FAA safety inspectors that she’ll make sure he gets plenty of rest before the flight on Christmas Eve.

Follow Santa’s progress on Christmas Eve at the NORAD Tracks Santa website: www.noradsanta.org

See how NextGen is going to improve the safety and efficiency of Santa’s rooftop descents: http://www.faa.gov/go/santa

LPC Continuing Education