The Dual Effects of Intellectual Property Regulations: Within- and Between-Patent Competition in The US Pharmaceuticals Industry1 1 We are thankful for comments on the paper by numerous seminar audiences and in particular by Stephen Propper and Ernie Berndt. Both authors are thankful for financial support from Pfizer Inc, Astra -Zeneca, and Merck & Co., and Philipson from The George
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Rejuvenation .docRejuvenate Your Life: Freeing Yourself From Chronic Unhappiness
What does it mean to rejuvenate? What does rejuvenation have to do How are you feeling? Now, and in general? What is depression? How is it diagnosed? Sad mood, Despair, Hopelessness, Guilt, Worthlessness, AnxietyLoss of Energy, Appetite, Pleasure, Interest Exhaustion and Changes in sleep- insomnia or can’t get out of bedDiminishing ability to Focus, Concentrate, or use MemorySuicidal Ideation Unrelated Aches and Pains-80% unexplainedTypes: Major Depressive Disorder, Bipolar Disorder, Post Partum Cognitive- Worry, Ruminations, Obsessions, Inaccurate ConclusionsBehavioral- Avoidance, Rituals, Excessive Safety Behaviors Physiological- Shakiness, Muscle Tension, Restlessness, Sweating, Cold Hands and Feet, Palpitations, Dry Mouth, Lightheadedness,Dizziness, Initial Insomnia, GI Upset, Frequent Urination Types: GAD, Social Anxiety, Phobias, OCD, Panic Attack, PTSD What are some of the biological causes for these conditions? Medical Problems -Depression-Cancer, Stroke, Parkinson’s Anxiety-Loss of Tactile Stimulation before 4 mo, Fetal Alcohol Syndrome,Increased Cortisol 2nd/ 3rd Trimester, Reactive amygdala Medications- Drug/Alcohol Abuse, Steroids, Hypertensive drugs (depression), Anticancer drugs, Decongestants & Asthma meds(anxiety) Rule Out for Depression- Anemia, Chronic Fatigue, Diabetes, Thyroid Disease. Rule Out for Anxiety- Endocrine problems, Heart Disease,Meniere’s disease What are some of the social factors that contribute to this distress? Depression- Loss of Social/Family Systems- Death, Divorce, Loss of Work, Care for a Ill Family Member, Isolation Anxiety- Loss of Support Emotionally or Materially How do psychological factors contribute to anxiety and depression? Early Abuse or Abandonment- Learned Helplessness, Negative Self talk, Habitually Unhealthy Expression of Emotions especially anger andneediness, Accommodation to False Self- unresolved thoughts not History of Depression- 1st –50% recurrence, 2nd 80-90% recurrenceAnxiety- Perceptual bias and Extreme Attachment to outcomes creates unconstructive suffering, “If only …” “things should be a certainway” Sleep- Guardian of Brain, Slow wave sleep- decr. With Caffeine,Alcohol (Mininal impact Sonata, Ambien, Lunesta, Rozerem)OK to take melatonin.5mg good after 6pm, Benadryl 25-50 Exercise- Long term effect Incr. Deep Sleep, Decr. Stress Reactivity, Incr. BDNF- Brain Derived Neurotropic Factor-Incr. Dendrites, Neuro. Repair, Protects from Cortisol Exposure to sunlight-10,000Lx 30-40 min/day Social Support- Calming, Destracting, Affirming, ProblemSolving, Material and Mechanical Support Diet- Complex Carbs, Protein, Regular meals, Caffeine (lessthan 250mg/day) Vitamins, Herbs and other supplements see handout Medication- Antidepressants, Inderal, Tranquilizers, BuSpar 50% respond to drugs, 70% depression recurs when Inpatient Treatments-ECT, Transcranial Magnetic Cognitive Therapy- Beliefs about Event affect Mood Event--Interpretation—Reaction….Most Useful Effect with SSRI’sNeurological connection between Mood and Negative Thought Loss/Separation/Rejection/Defeat-----harsh negative thought----feelings----physical reaction----fatigue/insomnia/aches/pains---- Mindfulness Based Therapies- Decr. Risk of Relapse by 50% with 8 week program especially with Hx RecurrentDepression Do you have any habitually negative thoughts about yourself? Do youactually believe them? Are they always true? What happens internally when you believe these thoughts? Who would you be or what wouldyour life be like if you didn’t believe them? Share with a partner. Then talk about how might you protect How do you nurture yourself? How do you honor your heart? Who isthe little kid inside you? How do you process emotions in your life?How do you experience emotions in your body? Information processing Problem in Depression and Anxiety Priorities of thought and attentionSort and Determine what to doRecall previous ExperiencesFixation of thoughts that made you unhappy Uncaring Unloved Cold Worthless HopelessSadness Awkward Clumsy Stupid Failure What are the triggers that recreate anxiety or depression in your life?What have you found helpful to diminish the triggering stimulus? How does mindfulness influence psychological health? Cultivate open-mindedness---Experience yourself in a dome Develop patience—Thoughts come and go, Feelings come and go---these pass like clouds in a sky, thoughts falling off a conveyor belt Consider compassion for yourself—Teflon mind, Serene Half Offer gentle persistence—Puppy Training for the mind What does the history of mindfulness suggest in our approach toemotional health? 1850 Thoreau/Contemplation/Walden Pond1900 William James; Buddism studied by everyone1940 Jung- Tibetan Book for the Dead 1960 Fromm- Buddism and Psychotherapy1971 Ram Dass; “Be here now”1979 Jon Kabat Zinn—MBSR/Center for Mindfulness Eating Disorders PsoriasisCancer Patients 1985 Techniques taught in Medical Centers 1993 Dialectical Behavioral Therapy –DBT Mindfulness, Interpersonal Skills, Emotional Regulation,Distress Tolerance-----Decr. Suicide and Hospitalization 1999 Steve Hayes—Acceptance & Commitment Therapy—ACT Striving to control makes things worse—Chinese Finger Trap 2000 Teasdale, Segal, & Williams –Decrease Relapse by 50% Mindful stretchingMindful Breath, Body, Sounds, Thoughts 3 Minute Breathing SpaceMindfulness Every Day What is mindfulness? What is NOT mindfulness? Mindfulness is a concept—“Sati” in Pali (spoken Sanskrit), Psychological context- Awareness of Present Moment with Rushing Thru Activities Spilling when not attending to it See things as they are rather than how we want them to beIncrease our attention to be present with choicesIncrease our ability to act skillfully Enrich our experience of the richness in the moment Slow down- greater detail, antidote for hurried culture Observe and Concentrate- Stabilizing Attention- choosing an object and follow it closely (example: breath, contents ofmind, TM mantra, less suffering- “Puppy training” for the mind.
Inner Focus and Outer Focus-allows identification with the moment rather than the narrative.(example: walking meditation, nature meditation, mountain meditation) Using the body and breath as a resource-body is a resource where you can inhabit the present moment especially withdifficult emotions May I feel safe and protectedMay I be happy and contentMay I be healthy and strongMay I be peaceful and at ease Three Minute Breathing Exercise- out of automatic, into Awareness- acknowledge thoughts, feelings, body “that Expanding- spacious awareness beyond breath, body How can you use mindfulness techniques to help yourself? Body as resource, especially when mood negativeThoughts and feelings are not facts Behavioral change more creative, less automaticExamples- pain, compulsive behavior, conflict in relationships,anxiety, panic, grief What will you do to support yourself in reclaiming your right to behappy when you leave today? Who will you ask to support you?
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