Блог Анкара

In This Chapter

^ Finding out what bodywork therapies are all about

^ Discovering what bodywork therapies can be good for

^ Examining the evidence

^ Knowing what to expect in a typical session

^ Knowing where to find safe and effective practitioners

Omplementary therapies offer so many ways to have your body moved, stretched, rocked, and restructured! Some of the therapies come from ancient medical traditions and have stood the test of time; some grew out of the pioneering development of osteopathy and chiropractic (check out Chapters 14 and 15 for more on these); others have been put together more recently.

The idea that all these therapies share is that misalignment and imbalance in your body can affect the function of your internal organs and body systems. Some also hold that your mental, emotional, and spiritual health can be affected too. The therapies are based on the belief that the body can be brought back into alignment or balance using physical manipulations, massage, stretches, or more subtle means. Some of the therapies mean working directly on your muscles, joints, and tissues – and you’ll certainly feel what’s being done to you! Others take a more subtle approach and focus on the so-called Energetic fields Around, or within, the body. In the case of these, you may not feel that much going on at all during actual therapy but transformations may start to occur afterwards.

Finding Out about Bodywork Therapies

In this section, I take you on a brief guided tour of popular bodywork therapies (in alphabetical order) and give you an idea what each involves, what

Evidence exists to support their use, and how you can find qualified practitioners so that you can try them out for yourself if you and your body are up for it!

Alexander Technique

The Alexander Technique was devised by an Australian actor, Frederick Matthias Alexander, in the late 19th-century after he suffered voice strain and voice loss and tried to devise ways to relieve his condition. Here’s some info about the Alexander Technique:

According to Alexander, years of poor posture, slouching, improper lifting, and muscular tension gradually have a negative effect on both the body and mind.

The Alexander Technique teacher is trained to identify these patterns of misuse in the body.

In a one-to-one or group session you’re taught to increase your awareness of correct body posture and to re-educate your body towards correct posture and the release of muscle tension.

Sessions generally last 30 to 45 minutes and are usually taken weekly, or sometimes twice weekly in the beginning, for at least 10 to 15 sessions.

Research on the Alexander Technique has suggested beneficial effects for musicians, actors, and sportspeople as well as those suffering from certain types of pain.

Costs vary from Ј35 to Ј100 per session.

In the UK, you can find teachers via the Society of Teachers of the Alexander Technique (STAT; Tel: 0845 230 7828; Www. stat. org. uk) whose members have all completed a three-year full-time training. You can also find teachers worldwide via Www. alexandertechnique. com.

Applied kinesiology (AK)

^M&if- Applied kinesiology (AK), derives from the term Kinesiology, Which is based

On the Greek word Kinesis Meaning movement or motion, and was developed ‘ /— ^ ‘ by American chiropractor, Dr George Goodheart, in the 1960s. He developed a way of muscle testing to determine the balance of structural, mental, and chemical (toxicity, allergies, and so on) health; three aspects that he called the Triad of Health. Here’s the lowdown on AK:

AK is used primarily for diagnosis and is based on the idea that every muscle is part of an Energy circuit That can be disrupted by toxicity, blockage, or illness. The strength of the circuit can be tested by isolating individual muscles and challenging them (see below).

Treatment consists of: (i) applying pressure to, or holding, certain energy points on the body to release blockages in the acupuncture meridian channels; (ii) gentle manipulation techniques to correct structural imbalances; and (iii) nutritional and lifestyle advice. Homeopathic, nutritional, or herbal supplements may also be recommended.

In a typical session the AK practitioner places one of your arms or legs in a particular position and then challenges the muscle by pushing against it and asking you to resist. If the muscle is strong you can easily resist the challenge. If it is weak then you have difficulty resisting.

AK challenges can be physical (directly pushing against the muscle), chemical (testing phials of allergens, bacteria and toxins, held against the body), or even mental (you, or the practitioner, holds a mental thought, such as of a nutrient or other remedy) while the muscle is tested.

Medics and sceptics find it impossible to accept that such diagnosis can be accurate and argue that little scientific evidence exists to support the theories underlying AK.

Research studies on AK (see the research section of Www. icak. com for details), suggest that certain muscles testing weak may be linked to certain physiological changes in the body. However, the research to date has not been sufficient, or good enough, to change the mind of sceptics. Nevertheless, AK is utilised by large numbers of chiropractors, natur-opaths, and other practitioners who say that they find this approach clinically useful.

Sessions generally last 30 to 45 minutes and may be weekly at first and then spaced out according to the health problem being treated. At each follow-up session, the muscles may be re-tested for improvement.

Costs vary from Ј40 to Ј70 per session and usually several sessions may be required.

Various offshoots from AK have been developed, including Health Kinesiology, Nambudripad’s Allergy Elimination Technique, BodyTalk, and more.

You can find AK practitioners via the International College of Applied Kinesiology (UK) (Tel: 01403 734321; Www. icak. com) whose members have all completed a 100-hour course.

Bates eye method

Bates eye method was devised by an American ophthalmologist, Dr William H. Bates, in the 20th century. He had really bad eyesight and his glasses broke one day while he was on holiday. He found that by the end of the holiday he could see better than before and determined to find out why. He concluded that misuse of his eyes and eyestrain had contributed to his poor eyesight and went on to devise a set of exercises to remedy these. Here’s some more info about the Bates eye method:

U The Bates method consists of a series of eye exercises to Re-educate Visual habits.

The exercises can be learnt from someone trained in the Bates eye method over six to ten weekly sessions or from self-help sources (such as books, videos, and online). The exercises require perseverance over a period of time and include splashing the eyes with alternating warm and cold water to increase circulation, blinking to cleanse the eyes and swaying while gazing on a fixed spot to relax the eye muscles, focusing on alternating near and far objects, and pressing warmed palms against the eyes to relax them.

*u Although research by Bates and his colleagues and anecdotal evidence is supportive of this technique, recent scientific validation is lacking and modern ophthalmologists and opticians remain sceptical.

*u Individual sessions are normally Ј40 to Ј50 per session but small group sessions may be as low as Ј8 per person.

*u You can find teachers of the Bates method in the UK and elsewhere in the world via the Bates Association for Vision Education (Www. seeing. org).

*u The Bates method also forms part of the work by Meir Schneider for his method of self-healing, which combines massage, movement therapy, visualisation, and breathing exercises. For more information, check out Www. self-healing. org or in the US call 00 (1415) 665 9574.

Bioenergetics

Bioenergetics was devised by American psychoanalyst Dr Alexander Lowen in the 1960s. Lowen had studied with the psychoanalyst Wilhelm Reich, a contemporary of psychiatrist, Sigmund Freud, and adapted their ideas to develop a body-mind therapy that he called Bioenergetics. Here’s the need-to-know stuff about bioenergetics:

U Bioenergetics is based on the idea that your body carries a physical memory of past traumas that are locked into the body in areas of muscle tension and rigidity.

U In a one-to-one or group session you’re taken through various physical positions and situations and encouraged to express the feelings that these unlock. For example, you may be asked to lean against another person for support and then find out what emotions doing so brings up, or you may be asked to adopt an open or closed body position and then connect with the physical sensations inside your body.

U Sessions can be great fun and energising but can also be quite dramatic as emotions like anger, hurt, and fear get released. I took a bioenergetics course years ago and remember lots of tears and catharsis in the group!

U Bioenergetics may be used to relieve specific physical or emotional problems or as a tool for increasing awareness and for personal development.

U Sessions generally last about an hour and small groups generally meet on a weekly basis for six to ten weeks. Costs vary depending on whether you have individual or group therapy.

U Only limited research exists on bioenergetics. Most of it documents experiences that people have had with the therapy rather than clinical trials.

U Therapists using this method need to be well trained to deal appropriately with the raw emotions that can come up and the dynamics of the group.

U You can find certified bioenergetic therapists who have trained for four to six years via the International Institute for Bioenergetic Analysis at

Www. bioenergetic-therapy. com.

Bowen technique

^ji)OTf The Bowen technique was devised by Australian Tom Bowen in the 1950s, ^^jT^X and later taught extensively by his students, Oswald and Elaine Rentsch.

Bowen had no previous training in any therapy or medical system. He simply wanted to alleviate suffering and always claimed that the technique was a ‘gift from God’. Here’s what you need to know about the Bowen technique:

U This therapy involves soft, rolling movements across different muscle groups through light clothing or on the skin, with the recipient lying on a treatment couch.

W Two-minute pauses occur between treatment of different muscle groups, during which the practitioner leaves the room in order to allow the body to Reset Itself by relaxing and readjusting itself.

U The technique is said to trigger electrical impulses in the nervous

System that release muscle tension and increase the circulation of blood and lymph. It is held that this enables joints, tendons, muscles, and so on to recover normal function and movement.

U Sessions last 30 to 45 minutes and having three sessions at weekly intervals is normal, with follow-ups as necessary.

U The technique has been used to treat chronic fatigue syndrome, all kinds of muscular pain and injury, menstrual problems, and so on.

U As yet no rigorous research exists to support this therapy, although a frozen shoulder trial is currently underway at the Metropolitan University of Manchester.

U Costs vary from Ј35 to Ј45 or so per session depending on the practitioner.

U You can find practitioners of the Bowen technique in the UK and

Worldwide via the Bowen Association (Tel: 0700 269 8324; Www. bowen-Technique. co. uk), or the Bowen Therapists’ European Register (Tel: 07986 008384; Www. bowentherapists. com).

Feldenkrais technique

The Feldenkrais technique is a system of ‘re-education’ for the body developed in the 1940s by Moshe Feldenkrais, who was born in the Ukraine and later settled in Israel. He applied his knowledge of engineering and his love of sports, especially judo – in which he was a second Dan black belt – to devise a technique that enabled maximum efficiency of the body with minimum effort. He was spurred on to create this therapy by the flare-up of an old knee injury that he wanted to be able to cure. Here’s the lowdown on the Feldenkrais technique:

U This therapy’s based on the idea that poor posture and inefficient movement of the body are linked to disturbances in the nervous system.

U Treatment consists of: (i) exercises that increase body ‘awareness through movement’; and (ii) gentle manipulation and touch techniques, known as Functional integration To help rebalance the nervous system and restore mobility.

U Feldenkrais technique may be learnt in groups or tailor-made in individual sessions, which usually last an hour and cost around Ј45.

U Feldenkrais has helped people with neck and back pain, stress, and tension, and is often used by dancers, actors, and sportspeople. Feldenkrais

Himself also pioneered its use with children and adults with severe disabilities due to, for example, cerebral palsy and stroke.

U Some studies have produced encouraging results for this technique but more research is needed.

U In the UK, you may find certified practitioners, who have trained for three to four years, via The Feldenkrais Guild UK (Tel: 07000 785 506; Www. feldenkrais. co. uk). In the US, the Feldenkrais Educational Foundation of North America (FEFNA) lists qualified practitioners (Tel: 00 (1800) 775 2112 (toll free); Www. feldenkrais. com).

Hellerwork

Hellerwork was devised by American engineer Joseph Heller in the 1970s. Heller was a prominent student of Ida Rolf (check out the section on Rolfing further on in this chapter), but later broke away to develop his own system with a greater emphasis on psychology and emotions. Here’s what you need to know:

U This therapy’s based on the same principles as Rolfing, namely that realigning the body and releasing tension in the muscle fibres can help alleviate pain and disease.

U It involves a series of eleven 90-minute sessions based on bodywork, movement, and dialogue. Costs are generally around Ј45 per session.

U The Bodywork Involves manipulation and deep pressure, similar to

Rolfing; the Movement Involves re-educating the body to move in stress-and tension-free ways; and the Dialogue Is where emotions that surface with the release of tension are explored.

U Hellerwork is most commonly used to relieve pain, stiffness and injury, mental and emotional stress, poor posture, and sports injuries.

U Only very limited research into Hellerwork exists, so it currently remains unproven.

U In the UK, you can find Hellerwork practitioners via Hellerwork International (Www. hellerwork. com).

Metamorphic technique

Practitioners of the metamorphic technique don’t diagnose or treat particular symptoms or ailments. Rather, their aim is to facilitate the person’s own natural metamorphosis by unblocking old Energetic patterns In the body and

Enabling self-healing and personal development. Here’s a snapshot of the metamorphic technique:

U The technique grew out of work by British naturopath and reflexologist Robert St John with autistic children in the 1970s. St John believed that certain physical, mental, and emotional patterns are established while in the womb and ‘held’ in the body. He found that by stimulating certain reflexology points on the feet that related to spinal reflexes (the reflexes connected to the spinal cord that send messages all around the body), these patterns could be released, and amazing, spontaneous changes would occur in the children’s abilities and personalities.

U Gaston St Pierre, a student of St John, went on to develop this Metamorphosis Approach into the Metamorphic technique, emphasising a detached attitude on the part of the practitioner, allowing the person to be their own direct agent of change.

U The technique is based on the idea that the body develops energetic patterns based on life experiences and that light touch on the spinal reflex points of the feet, hands, and head can enable these patterns to be transformed without any other intervention by the practitioner.

U The technique is performed one-to-one over one or more sessions of about one hour. You remove your shoes and socks and sit or lie down while the practitioner works on your feet, and then hands, and finally head.

U The technique is safe and suitable for anyone from babies to the elderly.

U No research exists to substantiate the theory behind this technique or its usefulness, but those who have had it say that it is relaxing and enjoyable and that it can be a powerful facilitator for change.

U Costs vary from Ј35 to Ј60 per session.

U You can find practitioners worldwide via The Metamorphic Association (Tel: 01424 432 566; Www. metamorphicassociation. org. uk).

Polarity therapy

This technique was devised by Dr Randolph Stone (formerly Bautsch), an Austrian who emigrated to the US. He qualified as an osteopath, chiropractor, and naturopath in the early 20th century, and made an extensive study of various Eastern spiritual disciplines, Oriental medicine, and the concept of Life Energy. The following is a summary of polarity therapy:

I U This therapy’s based on the idea that the body is surrounded by an

Electro-magnetic field. The head and right side of the body represent the positive electrical pole and the feet and left side of the body the negative electrical pole.

U The spine is the central axis for this energetic interchange and it has five energy centres corresponding to the elements of ether, air, fire, water, and earth, which relate to different areas of the body and body functions.

U For this therapy you lie on a treatment table in loose clothing or underwear and the practitioner uses light, medium, and deep pressure on certain points on the body to rebalance the energy fields while also engaging you in dialogue to increase self-awareness.

U Sessions last 60 to 90 minutes and are normally weekly over eight weeks or so, plus follow-ups as necessary. Dietary advice may also be given, based on a fresh food diet to clear toxins in the body. Polarity, yoga-type exercises, may also be recommended to aid this process.

U No research exists to prove the theory behind this approach or confirms its benefits, but it is rooted in such ancient traditions as Ayurveda and yoga, which have been practised for thousands of years.

U Costs vary from Ј35 to Ј60 per session.

U In the UK, you can find practitioners via the UK Polarity Therapy Association (UKPTA; Tel: 0700 7052748; Www. ukpta. org. uk) and in the US via the American Polarity Therapy Association (www.

Polaritytherapy. org).

Rolfing

Also called Structural integration, Referring to the correction of mis-alignment and imbalance in the structure of the body, Rolfing was devised by US biochemist Ida Rolf in the 1950s. Rolf researched yoga, osteopathy, and physical therapy, and came to believe that body alignment is essential to well-being. Here’s the lowdown on Rolfing:

U Rolf believed that poor posture, lack of fitness, emotional or physical stress, or injury can cause stiffness of the tissues, misalignment and later disease.

U She designed a system of ten, hour long treatments whereby the practitioner works through the body easing, stretching, and kneading the tissues to restore alignment.

U The practitioner uses fingers, knuckles, and elbows with firm pressure to achieve this ‘re-sculpting’ of the body. When I had Rolfing I found this pressure a bit painful at times! As the sessions progressed it was certainly the most penetrating tissue work that I had ever experienced. Nowadays, however, increasingly light techniques are used for increased comfort and some people don’t find it painful at all.

U The idea is to help your body to work with gravity rather than against it, and many people find this technique can ease pain and stiffness, relieve stress and tension, and more. Rolfing is often used by dancers, musicians, and sportspeople.

U A few research trials have confirmed that Rolfing can reduce stress, anxiety, and pain. Many medics and sceptics are prepared to accept Rolfing as a legitimate form of massage or therapeutic bodywork since the focus is specifically on realignment of the physical body.

U Rolfing is normally done over ten 60- to 90-minute sessions, with initial sessions on the superficial layers of the body, middle sessions at a deeper level, and final sessions on structural integration as a whole. Costs are about Ј75 to Ј95 per session.

U You can locate Rolfers worldwide via the Rolf Institute of Structural Integration (Tel: 00 (1303) 449 5978 or 00 (1800) 530 8875; Www. rolf. org).

Tragerwork

Tragerwork was devised by an American physiotherapist and doctor, Milton Trager, who also studied transcendental meditation (see Chapter 18). He became interested in how the subconscious mind could be used to release mental Programming Concerning disease or disability. The following is a summary of Tragerwork:

U This therapy utilises rhythmical, rocking movements to stretch the body and release stress patterns.

U The practitioner enters a relaxed state known as Hook up During which it is meant to be possible to sense areas of tension.

U When an area of tension is felt, then pressure is eased up, rather than increased, giving the recipient a sensation of lightness.

U The practitioner may also recommend special exercises known as

Mentastics That are designed to reinforce positive subconscious programming for health.

U Sessions last 60 to 90 minutes and may be repeated weekly over several weeks. You wear loose, light clothing and lie on a padded treatment table for the therapy.

U Initial research suggests that Trager work can help ease pain and stiffness. More research is needed.

U Costs vary from Ј35 to Ј60 per session.

U In the UK, you can find practitioners via Trager UK (Tel: 01903 717987; Www. trager. co. uk), and in the US via Trager USA (Tel: (001) 216 896 9383; Www. trager. com).

One of the things that gave Trager the idea for his therapy was witnessing the remarkable transformation of someone under anaesthesia. He watched a patient who suffered from terrible stiffness and pain become limp and relaxed while under anaesthesia, but then observed how the patterns of rigidity returned as the anaesthetic started to wear off. This

Observation gave Trager the idea of tension existing as ‘patterns’ in the body that are reinforced by the subconscious mind. He then experimented with using touch to RepatternThe tension in the muscles and tissues while also using a meditative, relaxed state to change habitual subconscious thought patterns.

Yoga, qi gong, t’ai chi, kum nye, and do-in

Each of the ancient Oriental medical systems has a movement/bodywork therapy as an integral part of its healing tradition. The idea is that through your own therapeutic bodywork you can keep your body fit, flexible, strong, and healthy; ward off disease; and delay the ageing process.

The main bodywork approaches in these traditions are:

U Yoga: Part of the Ayurvedic tradition, and meaning ‘union of body, mind, and spirit’, yoga includes static and moving poses (asanas) And breathing exercises (pranayama) For physical health and as a preparation for spiritual development via meditation, service, devotion, and so on. For contact details of yoga organisations, see Chapter 18.

U Qi gong: Pronounced ‘chee-kung, and also written Ch’i kung, It means ‘to work with’(or move) Qi. This is an ancient system of static or moving exercises, originally based on observation of animal movements. Qi gong is a part of Traditional Chinese Medicine (TCM), involves breathing and meditation, and is sometimes used to direct healing energy to diseased parts of the body.

U T’ai chi ch’uan: Derived from Chinese characters meaning Great,

Ultimate, And Fist, And often translated as ‘supreme ultimate power’, this ancient Chinese system of therapeutic exercises and breathing techniques is said to have grown out of qi gong. Often described as a Soft Martial art, t’ai chi is usually performed as a set sequence of a small or large number of movements (called short and long forms). T’ai chi is designed to increase the flow of ‘vital energy’, or Qi, In the body and to promote self-healing.

U Kum nye: Pronounced ‘Koom nyay’, This oral tradition of meditative, self-awareness exercises and poses (static or moving) is part of the Tibetan

Medical tradition. In recent years, this tradition has been formalised and brought to the West by the Tibetan lama, Tarthang Tulku, and his students.

U Do-in: Pronounced ‘Dough-in’, This system of exercises for personal and spiritual development is from the Japanese medical tradition and includes simple self-massage techniques and physical exercises.

These approaches are now practised worldwide by millions of people. They are quite different to the standard Western approach to exercise and body movement, which tends to focus on aerobics, exertion, and the ‘no pain no gain’ philosophy. In contrast, the Oriental bodywork systems are gentle and subtle, with a focus on breath and on moving ‘subtle energy’ in the body.

Yoga and qi gong have been the subject of increasing numbers of research studies that have shown both physical and psychological benefits but more research is needed to confirm how such benefits may be achieved.

Zero balancing

The Zero balancing technique was developed in the 1970s, by American doctor and osteopath Fritz Smith. He encountered acupuncture and became fascinated by the relationship between energy channels in the body and the structure of the body provided by the bones and muscles. Smith went on to train as an acupuncturist and gradually develop this approach, which got its name from a recipient who described the therapy as ‘like being returned to zero’.

U This therapy’s based on the idea that we have an invisible Energy body As well as a physical one and that a relationship exists between the two. If the energy body becomes blocked the bones and muscles that make up the deep structure of the physical body will be affected and vice versa.

U Treatment aims to restore balance in the flow of this vital energy by working on the body and breathing, and by promoting self-healing.

U Special attention is paid to important ‘shock absorber joints’, such as those in the foot that support the body’s weight, and also to your posture, breathing patterns, eye movements, and even the sounds of your stomach rumbling (all thought to give important clues as to the flow of this vital energy).

U In treatment sessions you lie fully clothed on a treatment table while the practitioner gently touches different points on the body and ‘holds’ stretches of the muscles. The stretches are held to a point of stillness, during which the body is thought to release tension and realign itself and the flow of Vital energy Is believed to be enhanced.

Sessions usually last 20 to 45 minutes and three weekly sessions, with additional follow-up as necessary, are often recommended. Zero balancing is sometimes combined with other therapies, such as acupuncture.

Little research exists to support the theory underlying zero balancing but those who have it report finding the therapy relaxing and enjoyable and some say that it helps reduce their pain and stress.

Costs vary from Ј35 to Ј65 per session depending on the practitioner.

In the UK, you can find teachers via The Zero Balancing Association UK (Tel: 01308 420 007; Www. zerobalancinguk. org). For practitioners in the US or other countries, check out the Zero Balancing Health Association (Tel: 00 (1410) 381 8956; Www. zerobalancing. com). All certified zero balancing practitioners have completed a series of training workshops including advanced training with Fritz Smith himself, who continues to develop the technique.

Helping Yourself with Bodywork Therapies

A really good way of relaxing, lengthening the spine, and easing tension, used as part of the Alexander Technique for re-educating the body, is the following:

U Grab yourself a couple of books of different thicknesses (content doesn’t matter because you won’t be reading them!).

U Lie on the floor (a hard surface is best but use a rug if the floor surface is cold) with your back flat and your knees bent up to allow the flat of your back to contact with the floor.

U Place two or three books under your head to allow your neck to feel relaxed and your spine straight.

U Adjust the position of your feet so that your knees and back feel at ease and comfortable. (If in doubt about your position, you can ask an Alexander Technique teacher to check it for you.)

U Place your hands comfortably folded on your abdomen.

U Breathe naturally.

U Focus your mind on your body and breathing and allow any tension to be released.

U Relax in this position for 5 to 15 minutes every day.

In This Chapter

^ Lowering your costs to stretch your coverage ^ Decreasing your expenses in the coverage gap

7he difference between a co-pay and the full price of a prescription drug can bring on serious sticker shock. And the increase in your out-of-pocket cost happens very suddenly if you cross the line into the doughnut hole, which I explain in detail in Chapter 15. So doing everything you can to stay clear of the gap makes sense. That means making the coverage you have at the beginning of the year last as long as possible. In this chapter, I suggest several ways to do that. Of course, these suggestions can help lower your expenses even if you’re unlikely to hit the doughnut hole.

And what if you fall into the gap despite your best efforts? Not everyone sees the gap in the same way:

Some folks with very high drug costs want to race through the gap to get to those generous catastrophic benefits as quickly as they can.

Others, also with very high costs, would like to do the same, but they simply don’t have the money it takes to get there. (Remember: You have to pay a large chunk on your own to get out of the gap.)

The majority of people have costs in the medium to high range and expect to fall into the gap but not get out of it before the end of the year.

If you’re in the second or third group, you’ll want to lessen the impact of the doughnut hole while you’re in it. In this chapter, I suggest ways to do that, too.

Stretching Your Coverage

That first slice of coverage in Part D, the phase known as the "initial coverage period," really isn’t very large. It Sounds Pretty good — coverage for up to $2,510 of drug costs in 2008 ($2,700 in 2009). But this amount isn’t just

What You Pay (read Chapters 2 and 15 for more about costs during the initial coverage period). It means the full cost of your prescriptions (what you pay And What your plan pays). And with drug prices as high as they are, it doesn’t necessarily take many meds for you to see your initial coverage swallowed up before half the year has passed.

I guess you’d prefer this not to happen to you. So somehow you need to s-t-r-e-t-c-h that coverage, which may turn out to be as healthy for your wallet as physical stretching is for your body — yoga for the pocketbook, perhaps. Even if you can save only a few dollars here and there, they all add up and stave off the sorry day when you may hit the doughnut hole. In the following sections, I highlight practical ways to do this, starting with one that may surprise you.

Taking a hard look at your meds

Think about all of the medications you take. Do you really need them all? This may sound like an impertinent question, but I don’t mean it that way. Many people are being over-prescribed without realizing it. In a health system where you can see many different doctors, and there’s little or no coordination among them, taking more meds than you really need is quite easy. Your primary care physician may prescribe two or three drugs, and various specialists may prescribe more.

JttNG/ This isn’t just a matter of cost. Some drug combinations can work against

Each other in subtle and complex ways that harm your health. And the more meds you take, the greater the possibility that this can happen. Researchers have also found plenty of examples of people developing new symptoms — for example, depression, headaches, or constipation — which are actually side effects of one of the drugs they’re already taking. But without realizing this, they go back to their primary care doctors who often. . . yes, prescribe yet more pills.

BED

Now don’t take this the wrong way. I’m not suggesting that you suddenly stop taking any of your drugs or lose faith in your doctor. Far from it. But make sure that all the medications you’re taking are necessary and safe when used together. If some aren’t, then cutting back will save you money And Protect your health.

The American Society of Consultant Pharmacists (ASCP), whose members are pharmacists specializing in medication management for older people, recommend that seniors review their prescriptions if they currently

F Take five or more medications f Take more than 12 medication doses a day f Take medications for three or more medical problems f See more than one physician who prescribes drugs on a regular basis

The following sections explain how you can get your meds reviewed.

Consulting your primary care doctor

^OOQj;^ Some physicians encourage patients to bring all of their medications into the office, and they’re often amazed to see the variety of pills that are poured onto their desks. So your primary care doctor may — and certainly should — welcome a request to review yours. You can either take in the containers or make a list of all the drugs you’re currently taking — not just prescription drugs, but also over-the-counter medicines, herbal remedies, and vitamins. If you make a list, make sure to include

F The full name of each of your drugs F Their dosages f How often you take them f How long you’ve been taking them f The name of the physician(s) who prescribed them

It’s a good idea to keep this list in your wallet and show it to any physician who prescribes a new medicine for you. Then the doctor can decide on the spot whether the new drug is really necessary or how it may interact with others you’re already taking. If you’re newly enrolled in Medicare Part B and go for your "Welcome to Medicare" exam — the only routine checkup that Medicare covers — this would be another opportunity to produce the list and ask the doctor to review it.

During this review, ask your doctor these specific questions:

F Do I still need this drug? If so, why? f Is this drug safe to take with all the others I’m taking? f Is this drug appropriate for people of my age?

F Does this drug perform essentially the same function as another drug I’m taking? If so, do I need both?

F Is there a medicine I’m not taking that I should be taking?

F Are there any changes I can make in my daily life that will make taking this drug unnecessary?

Turning to a pharmacist

Pharmacists are experts on the active ingredients in medicines, how they work in your body, and how different drugs may interact. In fact, pharmacists are more expert on this topic than doctors, and they’re often willing to spend more time answering patients’ questions, such as those I suggest in the previous section. You can ask for an appointment to see a pharmacist face to face to review your drugs, or you can drop off your list of meds and arrange to call later for the pharmacist’s opinion. Note: You may be charged a fee for the review.

If you live in an area that has a School of Pharmacy, you can inquire whether any of its advanced students are interested in performing a review. Many schools offer this service as part of students’ clinical training, under faculty supervision, at the school or in local clinics at little or no charge. To see whether there’s a school near you, go to the American Association of Colleges of Pharmacy’s Web site at Www. aacp. org and click "Pharmacy Schools." Or call the AACP at 703-739-2330.

A relatively small but growing number of pharmacists have been trained in pharmacology as it relates to seniors. They know the drugs that older people shouldn’t be taking, how some drugs cause additional symptoms that don’t affect younger people, and which meds are risky when used in combination with others. These pharmacists have CGP After their names, which stands for Certified Geriatric Pharmacist, A professional credential.

Many CGPs make regular visits to nursing homes and senior centers. If a CGP works in your community, you can make a private appointment for her to come to your home, review your meds, and, if necessary, discuss the results with your physician. CGPs typically charge a fee for this service — about $100 an hour — but if you take multiple meds, you may find it money well spent. To find a CGP, go to Www. ccgp. org/consumer/locate. htm and click your state, or go to Www. seniorcarepharmacist. com and click "Find a Senior Care Pharmacist in Your Area."

Qualifying for Medication Therapy Management programs

Part D plans are ideally placed to monitor the drugs their enrollees are taking because each plan has all (or most) of those drugs already logged into its computer system. Under the 2003 Medicare Modernization Act, Part D plans are required to offer what is known as Medication Therapy Management (MTM) For a certain group of enrollees. These are people who have several chronic diseases And Take multiple drugs that cost at least $4,000 a year.

You can’t choose to join an MTM program, but if your plan says you qualify and invites you to take part in one, consider doing so. The benefit doesn’t cost you anything — by law, you can’t be charged a fee. But know that what

The program actually does depends on the plan. At best, your plan may provide a face-to-face meeting or a telephone conversation with a pharmacist who can review your meds and suggest ways you can manage your health conditions more effectively. These may include recommendations for different or fewer medications, other drugs that may suit you better, or lifestyle changes that can improve your health and make you less dependent on pills. Some plans’ MTM programs fall short of this kind of service. You may only get an automated phone call reminding you to fill a prescription, or printed materials that give only general advice about your medical condition. If your plan invites you to join an MTM program, it sends details of the services it provides.

MTM programs in Part D are still relatively new. Over time, however, many of them may become more comprehensive, offering a valuable service to enrollees who take multiple drugs.

Switching to less expensive drugs

The most dramatic way you can lower expenses is to switch to less expensive drugs that work equally well for your medical condition. If you’re like many people, you may hesitate to mention cost as a problem when the doctor is writing out a prescription. And you probably think that if it’s what the doctor ordered, then that drug must be the best one for you. Well, maybe it is. Or maybe another one is far less pricey but just as good.

The fact is that the newest brand-name drugs — often the ones that doctors prefer to prescribe — are almost always the most expensive. Sometimes hugely expensive. (The nearby sidebar "What were they thinking. . . when they made prescription drugs so expensive?" explains some of those reasons behind the costs.) But often you have two other options: generic drugs and older brand-name medicines.

Checking out generic drugs

A Generic Is an inexpensive copy of a brand-name drug. It can be sold only after the original brand has been on the market for a number of years and its patent — which grants exclusive marketing rights — has expired. Generics may look different; they may taste different. But before they can be sold, the U. S. Food and Drug Administration (FDA) must certify that generics contain the same Active ingredients (the chemicals that work in your body to counteract disease or improve your health) as the brand-name drugs that they’re copying — and that they’re as safe. They should work exactly the same way.

What were they thinking. . . when they made prescription drugs so expensive?

When a pharmaceutical manufacturer brings out a new drug, it has exclusive rights under the patent laws to sell that drug without competition for a lengthy period, about 10 to 17 years. These laws allow the manufacturer to recoup the millions of dollars it has taken to research and develop the drug. While the patent protection lasts, the manufacturer tries to make as much money as possible from that drug — selling it at a high price, advertising it to consumers extensively on television, and sending legions of salesmen along to doctors to persuade them to prescribe it. The largest-selling (and most heavily promoted) medicines earn billions of dollars.

In recent years, drug companies have been heavily criticized for the tactics they use to keep profits high — sweetening sales pitches to physicians with gifts and free lunches, spending millions of dollars lobbying Congress and state legislatures to pass bills that are favorable to the industry and ditch bills that aren’t, and doing everything they can to extend patent protections and keep generic copies off the market as long as possible. When the first generic version does eventually go on sale, its manufacturer also gets six months of exclusive

Sales, so the drug costs only a little less than the brand’s price. But after that, more manufacturers produce generic versions and prices drop dramatically, often to less than 20 percent of the original brand price.

This market-based approach is unique to the United States, which has by far the highest drug prices in the world. Other Western governments regulate or negotiate drug prices in various ways to keep them affordable for consumers and taxpayers while allowing manufacturers a reasonable profit. In 2003, the American drug industry was successful in getting a clause written into the Medicare drug benefit law that specifically prohibits Medicare from negotiating Part D prices directly with the drug companies. (Instead, prices are negotiated by individual Part D insurers, who have far less bargaining power than Medicare.) Consumer advocates strongly opposed this ban, arguing that the Department of Veterans Affairs, also a federal agency, has long negotiated drug prices directly on behalf of the veterans heath service. Although Congress has passed several bills allowing direct negotiation for Part D, none (at least at the time I’m writing this) have yet become law.

Do they? Millions of people take generics and experience no differences between them and the original brands. Some people, though, are convinced that generics don’t work so well for them. It’s hard to say whether this is a psychological reaction or a real physical effect. But human bodies are both complex and highly individual. If an identical drug can affect two people differently, then so can a brand-name drug and its generic version — even if the only actual distinctions between them are the Non-active ingredients that provide a different color, texture, or taste. (And if these ingredients may affect your condition, your doctor will tell you.) The only way to find out whether a generic works for you is to try one — and to do so, perhaps, with the expectation that it will work as well for you.

Of course, not all of today’s brand-name drugs have generic equivalents. But over the last few years, a great many best-selling brands have lost their patent protection, and generics have surged onto the market. Generic versions of Tamoxifen (to treat breast cancer), Prozac (depression), Zocor (high cholesterol), and Norvasc (high blood pressure) — to name only a famous few — are available for a fraction of the cost of the originals. Many more will be developed in coming years.

Understanding what an "older" brand-name drug is

The newest and most heavily promoted drugs aren’t always brilliant innovations that are unique in treating a particular medical condition. Most of them aren’t very different from brands that have been around for a number of years. Often, their only claim to "newness" is offering more convenience — a pill you can take once a day rather than three times a day, for example — or even slighter variations. In 2002, the FDA approved 78 new drugs for market but classified only 7 of them as improvements over older drugs.

So why do consumers spend so much on these "new" drugs that are no better than old ones? The answer, largely, is television. Drug companies spend millions of dollars advertising their latest product to persuade folks that this is the drug of choice. "Ask your doctor. . .," they say. And if enough of us do, the drug becomes a blockbuster. A well-known example is Prilosec — remember "the purple pill" for heartburn? — which earned up to $6 billion a year until its patent expired in 2001. Its manufacturer then poured many more millions into advertising Nexium, a pill almost identical to Prilosec, except that it had a new patent and no generic competition. And many people bought Nexium, even after the FDA decided that Prilosec was safe enough to be sold without a prescription. Checking retail prices at a leading chain-store pharmacy, I found that a 30-day supply of 20 mg Nexium costs $168; generic Prilosec (omeprazole) costs $63; and over-the-counter Prilosec is just $20.

There’s another reason, besides cost, why older drugs may be a better bet than the latest ones out of the lab. They’ve been on the market for more years, and millions more people have used them. That means they have a longer track record showing how safe they are.

Determining how much you can save by switching

Just by using lower-price drugs, you stretch your Part D initial coverage, because the overall total cost of your drugs adds up to bring you closer to the doughnut hole. But you also reduce your co-pays. Generic medicines are almost always placed in the lowest tier of charges, often with co-pays under $10 for each prescription. A few plans charge nothing for generics. Older brand-name drugs often have lower co-pays too.

To see how this works, take a look at Table 16-1. It shows how one man (Jim) lowered his costs by well over a third and stayed out of the doughnut hole.

Table 16-1 How Jim Cut His Costs and Steered

Clear of the Doughnut Hole

Source: Dollar amounts derived from the 2008 Medicare Prescription Drug Plan Finder at

Www. medicare. gov.

Here’s how Jim achieved these savings. The least expensive Part D plan that covers all of his usual medicines — four brand-names and one generic — in 2008 was going to cost him $2,740 (including premiums totaling $282) over the whole year. It would also put him in the doughnut hole for the last four months — so in early September his out-of-pocket costs would jump from $174 a month to $337. But then Jim found generic versions for three out of four of his brand-name drugs. Under the same Part D plan, two generics would cost him $4 per prescription, rather than the $54 he’d pay for each brand, and the third would reduce the brand-name price by about 66 percent. Over the year, he’d pay $774 and cut his monthly costs to $64.50. So Jim talked to his doctor, changed to the generics, avoided the gap, and saved

Nearly $2,000.

If Jim had been in a plan that charged coinsurance rather than co-pays, he’d still have saved money. In one such plan, the total cost of his generics and single brand-name drug comes to less than $1,900, well short of the $2,510 that would put him in the gap. After a deductible of $275, his 25 percent coinsurance plus premiums would come to $66.10 each month from March through December, making his out-of-pocket cost $936 for the whole year.

When you’re considering generics, you can play savvy in another way too. Consider, for example, Prilosec, which is used to treat heartburn. Generic Prilosec (omeprazole), while costing far less than its brand-name version, still costs $63 a month at full price, three times as much as over-the-counter Prilosec ($20). However, if you’re in a Part D plan that charges, say, a $5 or $10 co-pay, or even no co-pay at all for generics, you’d be better off paying for the generic through your plan, at least in the initial coverage period, than buying the OTC version at full price. On the other hand, if you fall into the doughnut hole and have to pay the full price of generic Prilosec through your plan, the OTC version may then be a better bet.

Finding out more about lower-cost drugs

^jjfcDOQfy Your doctor is the best person to ask about whether a generic or older drug is " available because ultimately, if there is, she’s going to be the one who decides

Whether it would work well for you. You’ll also want to discuss whether an older drug may have other side effects or require a different dosage than the brand you’re taking now. (You’ll also want to make sure the generic or older drug is on your plan’s formulary. If it’s not, the plan will charge you full price.)

Your pharmacist, too, can be a good source of information on which lower-cost drugs are available. Or you can identify them by using the online Medicare Prescription Drug Plan Finder at Www. medicare. gov, as explained in Chapter 10.

You can also do a bit of homework yourself by exploring the value of different kinds of medicines that are used to treat your health problem. By "value" I mean which drugs are considered to provide the best clinical benefits in their class, according to head-to-head comparisons based on the best available scientific evidence. This kind of comparison is known as Evidence-based research And was pioneered by the Drug Effectiveness Review Project at the Health and Sciences University in Portland, Oregon. Each review investigates the safety, side effects, and effectiveness of all drugs used for a single specific medical condition — such as high cholesterol, diabetes, heart disease, allergies, depression, and many more. The resulting reports are increasingly used by doctors and big drug payers, such as state Medicaid agencies, to determine which drugs are most worth the money. After all, if five drugs are equally effective, why choose the priciest?

The scientific reports are difficult for most folks to read — they’re long and technical — but the Consumers Union has translated its results into free, easy-to-read summaries that consumers can use to help them discuss medications with their doctors. You can find these summaries at www. Crbestbuydrugs. org.

Buying drugs by mail order

Most Part D plans offer a mail-order service and charge less for drugs purchased this way. This option means ordering 90-day supplies at a time, so it works best for Maintenance drugs — those that need to be taken regularly throughout the year. Part D plans don’t charge extra for postage and packing in delivering orders to your door.

Be careful, though, to check that your plan’s mail-order service will actually save you money. Some plans charge exactly the same for mail-order drugs as they do for drugs bought at pharmacies. And a few plans don’t cover certain drugs on their formularies under the mail-order option — which means the ones omitted cost far more, maybe even full price. You can call your plan to

Check price differences for your drugs under the two options. Or, if you use Medicare’s online plan finder at Www. medicare. gov to see which plan will charge you the least for your drugs (as explained in Chapter 10), you can see this info at a glance.

But checking is worth it, because you may get lucky. Remember Jim, who I mention earlier in this chapter, saving a bundle by choosing more generic drugs and keeping himself out of the doughnut hole? He took it a step further and saved even more money, as you can see in Table 16-2. The plan he’s enrolled in charges nothing for generics bought from its mail-order service, so he pays only for his single brand-name drug plus the monthly premium, reducing his annual expenses by another $242. Lucky Jim indeed.

Shopping around for the best prices at local pharmacies

Prices for the same prescription drugs at local pharmacies can vary quite a lot, even within a plan’s network of pharmacies. That’s because the plan negotiates dispensing fees and other costs with each of these pharmacies and makes better deals with some than with others. (See Chapter 14 for the scoop.) This negotiating won’t affect you if you’re in the initial coverage period and paying flat co-pays for your prescriptions. But if you pay Coinsurance — a percentage of the cost of your drugs — or are paying full price in the deductible phase or the coverage gap, then you can probably shave a few dollars here and there off your prescriptions by shopping around.

Your plan includes a list of its pharmacies in your area in the information packet it sends you upon enrollment (or it can supply another on request), or you can view it on the plan’s Web site. You can also check out price differences among local pharmacies on Medicare’s online plan finder at www. Medicare. gov, as explained in Chapter 10.

What about those pharmacies that sell selected generic drugs at low cost, sometimes for as little as $4 for a 30-day supply? These pharmacies — Wal-Mart, Target, Safeway, and Kroger, among others — offer these prices year-round to all of their customers. (In other words, they’re not temporary discounts.) If any of these pharmacies is in your plan’s network, you have the right under Medicare rules to buy a covered drug at the pharmacy’s asking price through your plan when you fill the prescription. The payments count toward your out-of-pocket limit, and you don’t have to send the receipts to your plan.

For example, say that your generic medicine costs $4 at the supermarket. If your plan’s co-pay for this drug is $6, you’d save $2 by paying the supermarket price. Similarly, if your plan’s full price for the drug is $10, and your usual share is 25 percent of the cost ($2.50), you’d pay 25 percent of the supermarket price ($1) instead of $2.50. And if you’re paying full cost in the deductible phase or the coverage gap, you pay $4 rather than $10. (Of course, if your plan normally charges nothing for generics, the supermarket price isn’t a deal.)

Lowering Drug Costs in the Coverage Gap

I’m going to assume you’ve done everything you can to stay out of the coverage gap by following the advice earlier in this chapter and in Chapter 15 — but here you are still, pitched right into it. Of course, any of the suggestions earlier in this chapter can also help lower your expenses in the gap. Even at full price, a generic drug, for example, is likely to ease the sucker punch to your wallet more than a brand-name one will. But for many people, generics aren’t yet an option. According to one government report, 37 percent of Part D prescriptions dispensed in the first half of 2006 had no generic versions. So the following sections offer some alternative ideas.

Low-cost drugs from manufacturers

Many drug-making companies run patient assistance programs that offer their own brands for free or at very low cost to people with incomes under a certain level and no prescription coverage. When Medicare Part D began, these companies stopped assistance to people enrolled in the programs. Later, however, a few large companies changed course and now offer the same help to folks with Medicare drug coverage under certain conditions. Here are the pros and cons of patient assistance programs:

Pros: This is a good way of lowering costs dramatically in the gap if you don’t qualify for Extra Help under Part D or for your state’s pharmacy assistance program — provided that one or more of your drugs is made by a company that gives this help and you meet its eligibility conditions.

Cons: The value of these drugs doesn’t count toward the out-of-pocket limit that gets you out of the gap. The application process can be a hassle, and if each of your drugs is made by a different company, you may have to apply several times over. In some cases, this assistance is only temporary — maybe three months or so — or must be renewed through another application every year.

Each company has its own rules on eligibility for its program and how to apply. You’ll probably need your doctor’s recommendation. Your doctor or pharmacist may be able to tell you which of your drugs are covered by a manufacturer’s assistance program and may even have application forms handy. State Health Insurance Assistance Programs (SHIPs) offer help with applying (see Appendix B for contact info). So do some national associations and patient support groups that specialize in a particular health condition. The Web site Www. pparx. org lists company assistance programs, the drugs they cover, their eligibility rules, and how to apply.

Low-cost drugs from abroad

Prescription drugs are often much less expensive abroad because, unlike the U. S., most other governments regulate prices. Millions of Americans have saved money this way by filling prescriptions by mail order through the Internet, especially from Canada, or by hopping across the border. Here are the pros and cons of buying low-cost drugs from abroad:

I Pros: When you’re paying full price in the gap (and you don’t expect to get out of it), this option is worth considering. Brand-name drugs from abroad can cost half as much as the same ones here. Generics are usually not less expensive, but in some cases, you can buy new generics that are approved for sale in their own countries but not yet available on the American market.

I Cons: The cost of drugs from abroad doesn’t count toward the out-of-pocket limit that gets you out of the gap. Unless you take sensible precautions, you may fall victim to scams and counterfeits. It’s still illegal under American law to fill prescriptions this way. Nobody, however, has been prosecuted for importing drugs for their own personal use. Also, the recent falling value of the American dollar has made buying drugs from abroad less of a good deal than it has been in the past.

JfitBER The first rule of obtaining drugs from abroad is to Be careful. The Internet is ^ Wild West territory, full of scams for the unwary, and this is especially true

Jjljjl J of the trade in prescription drugs. So you’ll need to pick a licensed pharmacy that has a reputation for good, ethical service. To find out how to buy drugs from abroad safely, go to Appendix C.

Other options

When you’re in the doughnut hole and trying to make your expenses more manageable, every avenue is worth exploring. Depending on your circumstances, you may be able to get help to lower your costs in some of the following ways:

State Pharmacy Assistance Programs (SPAPs): I cover the big SPAPs that provide coverage to wrap around the Part D drug benefit, depending on your income, in Chapter 15. But many other state programs provide help with prescription drugs — for example, discount programs or low-cost drugs for specific medical conditions. To find out whether your state has a program, and its details, go to Www. medicarerigh. ts. org/rxframeset. html. Or call your State Health Insurance Assistance Program (SHIP; see Appendix B for contact info).

Free or low-cost clinics: Each state has clinics or health centers that provide health services, including prescription drugs in many cases, for which patients pay what they can afford. These services are supported by the U. S. Health Resources and Services Administration. For contact information in your state, go to ask. hrsa. gov/pc. Or call your state Department of Health or Area Agency on Aging. Look in the state pages of your phone book for contact info.

AIDS Drug Assistance Programs (ADAPs): These programs help people with HIV-AIDS pay for HIV-related medications. They operate in all 50 states, the District of Columbia, and the U. S. territories. To qualify, your income must be below a certain level, which varies from state to state. If you’re in one of these programs as well as a Medicare drug plan, you can use ADAP assistance to pay for HIV drugs in the coverage gap, though the payments don’t count toward the out-of-pocket limit. You can find details of each program at Www. atdn. org/access/states. Or call the AIDS Treatment Data Network at 800-734-7104 for help and information.

I Certified charities and patient organizations: If your income is low but a bit too high to qualify for Extra Help (which I cover in Chapter 5), you may be able to get help paying for drugs in the gap through a charity or a patient support association that specializes in a specific medical condition. These payments Do Count toward your out-of-pocket limit. To find such assistance, go to Www. benefitscheckuprx. org or call your State Health Insurance Assistance Program (SHIP) — see Appendix B for contact info.

I Pharmacy discounts: Many pharmacies offer discounts on drugs, either temporarily or through discount cards. If you happen to see that a discounted price is less than the price you’re paying under your Part D plan in the deductible phase or in the coverage gap (in other words, when you’re paying full price), you have the right to buy the drug at the pharmacy’s cash price instead of using your plan’s card. Provided that you send the receipt to your plan, this payment counts toward your out-of-pocket limit. (It’s only counted, though, if the drug is covered by your plan and the pharmacy is in the plan’s network of pharmacies, as explained in Chapter 15.)

I Free samples from your doctor: If you have trouble paying for drugs in the gap, don’t be shy about asking your doctor for free samples, which most doctors receive from drug manufacturers. It’s one way the companies persuade doctors to prescribe their products — most often the newest and most expensive ones. For this reason, the drug you need may not be in your doctor’s sample cupboard, but it’s worth asking.

Chapter 17

In This Chapter

Knowing when your anger’s problematic ► Developing healthy anger

Communicating effectively to combat unhealthy anger

I\ Nger’s a pretty common emotion. However, anger is also increasingly Ґ \ recognised as an important emotional problem. Anger can be bad for your relationships, your health, and your self-esteem.

In the bad old days of psychological treatment for anger, people were encouraged simply to ‘get it out’, often by beating pillows to vent their fury. The result? Just like anything you practise, these people got better at being angry. The notion that expressing your rage can ‘get it out of your system’ is something of a myth. More often you wind yourself up further, generating even more anger. A better solution is to get to grips with managing your angry feelings responsibly, and to master skills that can help you to feel less angry, less often.

CBT offers clear and effective management of anger, by tackling the thinking that underpins your anger and helping you express that anger in a healthy manner. This chapter focuses on CBT techniques that can help you deal directly with your feelings of anger.

Discerning the difference beWeen Healthy and Unhealthy Anger

Essentially, two different types of anger exist – healthy and unhealthy:

Healthy anger is helpful annoyance and irritation. This is the kind of anger that spurs you on to assert your rights when it is important that you do so.

Unhealthy anger is unhelpful rage, and hate. This type of anger leads you to behave aggressively or violently even in response to mild or unimportant provocation.

All emotions have Themes – That is, sets of circumstances or triggers from which they arise (we explain this a bit more in Chapter 6). Themes for anger include someone breaking one of your personal rules, or threatening your self-esteem through word or deed. Another anger theme is frustration, when someone or something gets in the way of you reaching a goal.

The triggers for healthy and unhealthy anger are the same, but the behavioural responses they typically produce are very different. Both anger types are also associated with different ways of thinking and attention focus.

Key characteristics of unhealthy anger

Unhealthy anger is far more likely than healthy anger to cause fractures in your personal relationships, create trouble in your workplace, or land you in prison. You’re also likely to feel more physically and emotionally uncomfortable when you’re unhealthily angry.

Several ways of thinking typically underpin unhealthy anger:

Holding rigid demands and rules about the way other people must or must not behave

Insisting that other people must not insult or ridicule you

Demanding that life conditions and other people don’t get in the way of you getting what you want

Overestimating the degree to which people deliberately act in undesirable ways towards you

Assuming automatically that you’re right and the other person’s wrong Refusing to consider another person’s point of view

Common behavioural characteristics associated with unhealthy anger include the following:

Attacking or wanting to attack another person physically or verbally

Attacking another person in an indirect – also known as Passive-aggressive – Way, for example trying to make someone else’s job difficult

Taking out your anger on innocent parties, such as another person, an animal, or an object

Plotting revenge

Attempting to turn others against the person you believe has behaved undesirably

Sulking

Looking for evidence that someone has acted with malicious intent Searching for signs of an offence being repeated

Being overvigilant for people breaking your personal rules or acting disrespectfully towards you

Common physical signs of unhealthy anger include the following:

Clenched fists

Muscular tension, especially in the neck and shoulder muscles Clenched jaw Trembling or shaking Raised heart rate I Feeling hot

For many people, anger can come on hot and fast. Familiarising yourself with your own early warning signs of anger can help you to intervene earlier.

Hallmarks of healthy anger

In general, people experience healthy anger as intense but not overwhelming experience. You can feel intensely angry in a healthy way without experiencing a loss of control. Healthy anger does not lead you to behave in antisocial, violent, or intimidating ways.

In addition, healthy anger is typically underpinned by the following ways of thinking:

Holding strong preferences rather than rigid demands about how people should act

Having flexibility in the rules you expect people to abide by

Strongly preferring that others don’t insult or ridicule you

Desiring that other people and life conditions don’t get in the way of you getting what you want

Thinking realistically about whether other people have deliberately acted undesirably towards you

Considering that both you And The other person may be right And Wrong to a degree

Trying to see the other person’s point of view Behavioural characteristics typical of healthy anger include: Asserting yourself with the other person

Staying in the situation with the intent of resolving any disagreement

Requesting the other person to modify her behaviour – and respecting her right to disagree with you

Looking for evidence that the other person may not have behaved with malicious intent

If you’re serious about overcoming your unhealthy anger, you have to take a long hard look at some of the attitudes you hold. This involves honestly looking at the way you believe that other people and the world at large Must Treat you. You may hold some common toxic beliefs that frequently lead to unhealthy anger in people. Some of these toxic thoughts include:

No one must ever treat me poorly or disrespectfully.

The world must not be unjust or unfair and Especially Not to me!

I must get what I want when I want it and nothing should get in my way.

I must never be led into feeling guilty, inadequate, embarrassed, or ashamed by other people or life events.

No one and nothing must ever expose my weaknesses or errors.

Having looked long and hard at your attitudes, you need to make your toxic attitudes more helpful and realistic (see Chapter 3 for more on tackling toxic thoughts in general). Yes! Once again, positive emotional change comes from changing the way you think about yourself, about other people, and the world in general. If you want to be emotionally healthy and high-functioning, you need to start developing flexible, tolerant, and accepting attitudes.

High-functioning individuals experience fewer disturbing emotional responses, they are able to enjoy life, and they bounce back fairly readily from everyday hassles and annoyances. It’s all in the way you look at life and the kind of attitude you take toward life’s ups and downs (particularly with regard to anger).

We can explain the types of attitude that are likely to help you overcome unhealthy anger. However, You Must decide to agree with these attitudes and ultimately Act in accordance with them If you want to see a change in the amount of anger you experience.

The following sections describe the healthy attitudes that you need to take in order to overcome your unhealthy anger.

Putting up With other people

Other people exist in the same universe as you. Sometimes, this can be a rather pleasant state of affairs, but on occasions you may find that these other people are a damnable inconvenience. Whether you like it or not, other people can exist, do exist, and will continue to exist in your universe for the foreseeable future. Accepting that these other people have as much right as you to inhabit the planet just makes sense. And while cohabitating, you may as well accept the reality that sometimes other people may get on your nerves. As you’re not in charge of the universe, you’d better accept that other people are Allowed To act according to their rules and values – not yours.

You’ve probably noticed that humans come in a variety of shapes, sizes, and colours. No doubt you’ve seen that not all people share the same religion, culture, political opinions, moral codes, or rules of social conduct. Now, without going into a long-winded speech about the value of diversity, accepting individual difference is terribly important. Acknowledging that other people have a right to their own ideas about how to live their lives – even when you flatly disagree with their ideas – can save you a lot of emotional upset. People will continue to exercise these rights, whatever your opinion.

Accepting others can save you a world of unhealthy anger. Consider this: Every morning Jill and Tim travel to work together by bus. Every time she boards the bus, Jill says a pleasant ‘Good morning!’ to the driver, who always ignores her completely. One day, Tim asks Jill why she persists in greeting the driver, even though he never acknowledges her. Jill says: ‘Because I choose to behave in line with my standard of politeness rather than to respond to his standard of rudeness.’

Jill’s high tolerance to rudeness from the bus driver means that she can avoid making herself unhealthily angry. She does this by:

Accepting that the driver has the right to be rude. No law exists against responding (or not) to another person’s greeting.

Not taking the driver’s rudeness over-personally. The driver doesn’t know Jill, so it is highly unlikely that he is actually ‘out to get her’ specifically. He’s probably foul-tempered to many people in addition to Jill.

Exercising her right to behave according to her own standard of politeness, even in the face of another person’s rudeness. Although the bus driver is rude to Jill, she chooses not to respond in the same way. She can carry on being a generally polite person even in the face of another person’s rudeness if she so chooses.

Forming flexible preferences

Wanting others to treat you well and with respect makes sense. Similarly, you probably want other people to do their jobs well and to help you to get what you want. You’re likely to want life to roll your way and for world events to gel with your personal plans.

However, expecting and demanding these conditions to be met all the time doesn’t make sense!

Keeping your attitudes flexible and based on Preferences, Rather than demands or expectations, can keep your anger in the healthy camp. Rigid and demanding attitudes can land you in unhealthy destructive anger, time and time again.

Consider the relationship of Ade and Franco: Ade holds rigid beliefs about other people showing him respect and courtesy. Franco holds the same principal attitudes, but flexibly. Ade and Franco go for lunch together and sit near a table of young men, who drink a bit too much and end up talking very loudly and rudely. Franco and Ade can’t hear each other and their lunch is being ruined by the behaviour of these young men. Franco suggests that he and Ade move to another table, where they won’t be disturbed by the men’s antisocial behaviour. Ade, however, gets up and shouts at the men, ending up in a brawl outside the cafe. He’s lucky not to be hurt more seriously than he is.

Ade’s rigid attitudes about the situation are:

‘How dare these idiots treat me this way?’ ‘I won’t tolerate being disrespected like this.’ ‘I’ve got to show these idiots who’s the boss.’

Franco’s more flexible attitudes about the situation are: ‘These guys are behaving like idiots.’

‘These guys are really annoying me with their disrespectful behaviour.’ ‘I don’t want to put up with this, so I think I’ll get away from these guys.’

Flexible preferences for things like respect allow for the possibility of you being treated disrespectfully. Rigid demands don’t allow for the possibility of life and other people treating you in ways that you think they shouldn’t. Inevitably, you can end up feeling outraged if you always demand that others behave in a specific way. People behave according to how They Want to behave – not how You Want them to behave.

Accepting other people as fallible human beings

When you angrily condemn another person as ‘useless’, ‘no good’, or ‘idiotic’, you make a gross overgeneralisation. The other person isn’t a thoroughgoing idiot just because she’s acting idiotically – she surely acts in different ways in other situations, just like you do.

The critical point here is also a practical point: Putting down other people makes respecting others difficult. You need to sustain a level of respect for others in order to be able to consider behaviours objectively and act appropriately assertive.

The alternative to putting down others is to accept them as FHBs – fallible human beings – who may act in objectionable ways (to you). When you consider others as FHBs, you can appropriately condemn the behaviour but not the person. This acceptance is critical in helping you to keep a level head and master your angry feelings.

Accepting other people is the other side of the coin to accepting yourself. You can eventually accept yourself because you’re essentially applying the same philosophy to everyone.

Accepting yourself

Sometimes, people default to unhealthy anger because they have a fragile sense of their own worth. If someone treats you poorly, insults you, or seems to hold a negative opinion of you, you may be reminded of how low an opinion you have of yourself. In order to protect your self-worth, you may attack the other person. Think of the rationale as ‘If I can put you down, then I can avoid putting myself down.’

By believing that you’re an unrateable, complex, ever-changing, fallible human, you may see that you can never be less worthwhile, even when people treat you poorly. In Chapter 12, we offer more guidance on self-acceptance.

Developing high frustration tolerance

Frustration Occurs most often when something or someone gets in the way of you achieving your specific goals and aims. The more important your goal is to you, the more angry or annoyed you’re likely to feel when something blocks your attempts to reach that goal.

People who frequently experience unhealthy anger tend to have a low tolerance for frustration. Their low threshold for tolerating hassle, mishaps, or obstruction from others is echoed in statements like these:

‘I can’t stand it!’ ‘It’s intolerable!’ ‘I just can’t take it anymore!’

Increasing your tolerance for frustration helps you to experience appropriate levels of healthy annoyance in response to goal obstruction. Having a High frustration tolerance (HFT) makes you more effective at solving problems. So, your anger doesn’t get in the way of you seeing possible solutions to everyday hassles and setbacks. High frustration tolerance is present in statements such as:

‘This is an uncomfortable situation but I can stand the discomfort!’

‘This event is hard to bear but I can bear it – some difficult things are worth tolerating.’

‘Even if I Feel Like I can’t take it anymore, chances are that I can.’

To increase your tolerance for frustration, ask yourself these kinds of questions when life pulls a fast one on you:

‘Is this situation really terrible or is it just highly inconvenient?’

‘Is it true that I can’t stand this situation or it is it more true that I don’t like this situation?’

‘Is this situation truly unbearable or is it really just very difficult to bear?

Being less extreme in your judgement of negative events can help you to have less extreme emotional responses, such as unhealthy anger.

Doing your ABCs

Practise writing down your unhealthy angry thoughts on paper and replacing them with healthier thoughts. Refer to Chapter 3 to see how to use an ABCform to tackle toxic thoughts

And replace them with realistic renderings, pertinent preferences, additional acceptances, self-acceptance, and high frustration tolerance.

IBE*

Most of what you think is intolerable isn’t as bad as it seems. Many things are difficult to tolerate but are tolerable, hard to bear but bearable, unpleasant and inconvenient – but you Can Stand them!

To underscore the point, imagine getting stuck in traffic on your way to the airport and then missing your flight. Deeply annoying! However, by you getting angry and screaming at the traffic, isn’t going to make the cars move any faster. Of course, becoming healthily annoyed about the traffic doesn’t change the situation either. But your healthy anger is less likely to cause you such extreme discomfort and is more likely to help you create a contingency plan. Rather than using up your energy swearing and bashing your mobile against the dashboard, you can focus your efforts on phoning the airline and trying to get yourself bumped on to the next available flight.

Pondering the pros and cons of your temper

Believe that you’re Right to Be angry and steadfastly stick to this perception, is one of the more common obstacles to conquering unhealthy anger.

You certainly have the Right To feel angry. You may even Be right To be angry, in the sense of objecting to something you don’t like. However, you may feel better and behave more constructively if you have Healthy Anger rather than Unhealthy Anger.

To commit more fully to changing your anger, review the costs and benefits of your current anger, and of a healthier alternative. Refer to Chapter 8 for some pointers on completing a cost-benefit analysis, which can help you to facilitate this change.

Imparting \lour Indignation in a Healthy Way

Expressing your feelings readily when they occur can be a good antidote to bouts of unhealthy anger. On the other hand, bottling up your feelings can mean that you fester on your emotions until they bubble up to the surface and you explode.

People who talk openly and appropriately about their emotional responses to events are less prone to unhealthy feelings like anger and depression. The following sections offer tips and techniques to improve your communication skills and to deal with dissatisfaction in a healthy manner.

Asserting yourself effectively

Assertion Involves standing up for yourself, voicing your opinions and feelings, and firmly ensuring that your basic rights are considered. Assertion differs from aggression, in that it does not involve violence, intimidation, or disregard for the rights of others.

Using assertion rather than aggression is more effective in getting you what you want. When you’re being assertive, you’re still in control of your behaviour, but when you’re unhealthily enraged much of your behaviour is impulsive.

LBEJ»

People are likely to respond to your wishes when you’re being assertive simply because you’re making yourself clear – not because they’re afraid of your anger.

Often, your aggression is about winning an argument and getting the other person to back down and agree that you’re right. Assertion is not about winning per se. Rather, assertion is about getting your point across but not insisting that the other person agrees with you or backs down.

If you have a tendency to become angry, and get verbally or physically aggressive quickly, give yourself time out and go and count to ten (or as high as you need to feel calmer). You can then consider your next thinking and behavioural steps.

Assertion is a skill that you can practice. Many people with anger problems benefit from breaking down assertion into the following steps:

1. Get the other person’s attention. For example, if you want to make a complaint in a shop, wait until you have the shop assistant’s attention rather than shouting at them when they are busy with another task. If you want to talk to your partner about a specific issue, ask for some of her time.

2. Be in the right place. The best time to assert yourself may depend on where you are when you get irked. If your boss makes a comment that undermines you during a board meeting, you’re probably best to bring it up with her a bit later in less public surroundings.

3. Be clear in your head about what you want to say. If you’re new to assertion, but more familiar with the shouting and screaming thing, give yourself time to really think about what you want to get across.

4. Stick to your point and be respectful. Don’t resort to name-calling or hurling insults.

5. Take responsibility for your feelings of annoyance. Don’t blame the other person for Making You feel angry. Use statements like ‘I feel angry when you turn up an hour late for our appointments’, or ‘I felt let down and angry that you didn’t invite me to your wedding reception’.

Assertion doesn’t always work. Simply because you make the superlative effort to stop yelling your lungs out and to stop battering other people about the head and ears, doesn’t mean that you’re always going to get what you want. Oh, no, siree Bob! In fact, some people may even meet your assertion with their own aggression. So, strive to maintain your healthy anger and to behave assertively, even when other people don’t. Remind yourself that other people have the right to choose to behave badly and that you have the right to remove yourself from them rather than responding in kind.

Before you assert yourself, decide whether the situation’s really worth your time and energy. Ask yourself whether the problem merits you being assertive. Is the issue more trouble than it’s worth? If you’re a former unhealthy anger junkie, you’re probably not used to just letting things go. You can practise deciding when asserting yourself is in your best interests and when you’re wiser to simply not respond at all.

Coping With criticism

Criticism isn’t always intended to anger or undermine the receiver. Well-delivered specific criticism can provide useful information and need not cause offence. Most people like to hear positive feedback – it’s the negative stuff that really gets under your skin.

People who demand perfection from themselves, or expect approval from significant others, can often take criticism badly. They tend to take criticism overly seriously and personally. They often assume that any form of negative comment means that they’re less than worthy. If you’re this sort of person, a comment from your boss such as ‘I’m not entirely happy with this report you’ve written’ gets translated in your head something like this:

My boss thinks my report is rubbish rubbish at my job = I’m rubbish

All my reports are rubbish = I’m

You may even become unhealthily angry in an attempt to defend your self-worth, and launch a counteroffensive on the person you feel has attacked you.

You can take the sting out of criticism by keeping these points in mind:

Criticism can help you to improve your work performance and your relationships.

You can assess criticism, decide how much of it you agree with, and reject the rest.

Criticism is something pretty much everyone experiences from time to time. You cannot reasonably expect to always avoid being criticised.

If someone criticises you in a global way – for example, your sister calls you an incompetent loser – try asking her to be more specific: ‘In what specific ways am I an incompetent loser?’ Asking questions can make the criticism more useful to you. Or, if the person cannot be more specific, your question can disarm her. The following section discusses disarming in greater detail.

Using the disarming technique

Okay, not all the criticism that you get is well-intended. Sometimes, another person may bombard you with a load of negative remarks or insults. What are your options? You Can Get unhealthily angry and shout at or otherwise attack your antagonist. Or, you can keep your annoyance in the healthy camp and try non-defensively disarming your critic. The disarming technique works on the following principles:

Look for a grain of truth in what the other person is saying and agreeing with her on that specific point.

Show your critic some empathy

Ask your critic for more information about her point of criticism Express your own point of view as ‘I feel’ statements

For example, Hilda’s friend criticises her for being late to meet her for coffee. Hilda’s friend says angrily: ‘You’re always late. You’re just so disorganised!’ Hilda would usually be defensive and hostile about criticism, resulting in many past arguments. Instead, this time Hilda uses the disarming technique and replies, You’re right! I’m not the most organised person in the world’ (partial agreement). ‘Are you feeling really annoyed?’ (empathy/asking for more information). This takes the heat from her friend’s anger, who then goes on to say how frustrated she’s feeling in general.

Using the disarming technique, you come out on top by keeping your cool. You also gain the satisfaction of having managed a critical comment well. Who knows – you may even Improve Your relationship with your critic.

Even if you know that your anger responses are causing you problems in your life, you may still be reluctant to let go of your anger. Sometimes, people are reluctant to break free from unhealthy anger and related behaviours because they can’t see an alternative, and think that they may end up being passive or getting walked over instead.

However, if you develop your assertion skills, you may well be more inclined to let go of your anger. Nevertheless, here are some common obstacles to getting rid of unhealthy anger and some suggestions to help you take on healthy anger instead:

You lack empathy and understanding of the impact your unhealthy anger responses have on those near to you. When you’re not angry, ask your loved ones how they feel about your anger. Try to remember times when you’ve been on the receiving end of aggressive or intimidating behaviour and how it affected you. Use feedback about your anger, and your own experiences of aggression from others, to help you change how you express feelings of annoyance in the future.

Letting go of your anger means that you’re weak. You may consider yourself an angry person, and you may like it that way. You may think that if you don’t continue to be angry, other people may discover that you’re weak, a pushover, someone they can mess with. Work to realise that people who’re assertive – firm but fair – tend to earn respect. You don’t need to be angry to be strong.

You think that your unhealthy anger helps you to control other people and encourages them to respect you. If you’re very aggressive, people who are important in your life, such as your children or your partner, may go out of their way to avoid incurring your wrath. Don’t mistake fear and dislike for respect. You may control the people in your life by your anger, but their compliance is likely born of fear and loathing, not from genuine regard for you. When you behave respectfully and assertively, people are likely to respond out of a genuine regard for your feelings rather than out of fear.

Your unhealthy anger makes you feel powerful. Although some people find the intensity of their unhealthy anger pretty uncomfortable and even scary, others feel invigorated by the rush of their fury. Unhealthy anger is based on putting down another person. Unhealthy anger often means that you are stepping on another person’s rights, or abusing, or intimidating somebody else. If you enjoy these aspects of your anger, you probably hold a low opinion of yourself generally. Look for other ways to experience your personal power without undermining those around you.

Your anger is self-righteous. You may be clinging stubbornly to your anger because you think it’s justified. You may be refusing to admit that you could be wrong or that the other person could be right. Rarely are confrontations as cut and dry as one party being utterly in the right and the other utterly in the wrong. Remind yourself that it is okay to be wrong. It is not a sign of weakness or inferiority. Allow yourself to admit that you may be wrong and that the other person may have a good point.

Feeling a bit sceptical? Test out your predictions about adopting healthy anger and behaving in an assertive rather than an aggressive manner. You can use the blank behavioural experiment sheet in Chapter 4. (Refer to Chapter 4 for more help on conducting behavioural experiments.)

Body benefits for bridling your anger

Being angry, especially feeling frequently hostile towards other people and the world, is bad for you. Scientific research shows an association between hostility and raised blood pressure.

Which can lead to heart problems. Take the pressure off your mind, your interactions with other people, and your heart by controlling – rather than being controlled by-your anger.

# • m • # % m m % * * *» * * * & « * * % # * * # ** * *» * « * <§ * * • * • • # # # # # #

/w W/s Chapter

► Understanding spas

► Choosing the right spa

► Looking at fantastic spa treatments

► Finding massage specialty stores

Јver notice how some people seem like they were born with a silver-plated bottle of Evian water in their mouths? They’re the ones out there living it up at expensive luxury spas, getting all the massages, right? Not!

Over the past decade, the household income of the average spa-goer has dropped from around $500,000/year down to about $50,000/year. That one "0" makes a lot of difference. Today, spas are for everybody. If you’re not making $50,000/year, don’t despair. With the advent of Day spas, Which I describe in this chapter, the experience of luxury is becoming even more accessible to people from all walks of life. And, if you’re steadfastly opposed to spending money, this chapter also contains a few tips and techniques to turn your very own home into a luxury spa, almost for free.

Spas: More than Just a Pretty Jacuzzi

Spas are not, as commonly believed, just a kind of Jacuzzi. Although the word Spa Has become interchangeable with Hot tub, A spa can also be a really cool place where all kinds of exciting things take place, like chardonnay grape massages for instance.

Back in the good old days of King Louis’ court in France (it may have been Louis XV, or XIV, or perhaps VIP… I’m not sure), certain ladies-in-waiting found themselves waiting around so much that they began feeling jaded. "Another typical almond-oil massage from our love slave, Gregory?" said one lady to the next. "How boring."

So, they came up with a new idea. Their servants filled huge vats with smashed chardonnay grapes, and the ladies proceeded to jump in Au naturel For a total-immersion aromatherapy experience. The sensation was so new, and the positive effects of the grapes on their skin so pronounced, that they decided to make it a tradition.

Thus was born an early version of a spa treatment that can still be experienced today. At the Meadowood Spa in Napa Valley, California, for example, they offer a treatment based on this theme (ladies-in-waiting not included). The distilled essence of chardonnay grapes is infused into the massage cream used by the massage therapists there.

Choosing a Spa

Today, whether you plan to immerse yourself in grapes, or to simply try to lose a few pounds and look your best, you can choose from a large array of spas to visit. They range from super-luxurious to down-home rustic. So how do you decide where to go?

Spas = H20

What is a spa anyway, and what does the word spa really mean? Originally, it was a Latin acronym from the words, Sanitas Per Aqua, Meaning Health through water. This was a phrase favored by the Romans, who took those three words with them everywhere they went, including a town in modern-day Belgium that had healing hot spring waters bubbling out of the ground. They called this town Spa, perhaps

Also in reference to the Latin words ‘espa’ (meaning "fountain") and ‘sparsa {from Sparg-ere, Meaning, "to bubble up").

You can go to Spa, Belgium, and immerse yourself in the waters there. Visit 209.41.63. 136/spa/spa. htm On the Web to find out

First, knowing what kinds of spas are out there helps. Spas fall into three basic categories:

Destination spas: This is the King Louis kind of spa, the type of place you go when you want a super special experience. They’re called Destination spas Because they are dedicated to the spa experience and nothing else. When people visit them, the spa is their final destination, and they usually stay for several days to a week.

^ Resort spas: Becoming more and more popular, these spas are an important part of a larger resort. Guests may travel to the resort for other reasons, but many of them take advantage of the spa while they’re there.

Day spas: The fast food joints of the spa world. Day spas are places to go to receive spa treatments, massages, and more, and you don’t have to travel far or stay overnight to do so.

Visiting the spa douln the street

These days, you can probably find a day spa available right in your very own neighborhood. Several multimillion dollar day spas have opened recently, but the majority existed first as hair salons that expanded into spa services. Some good massage is going on at day spas, because many skilled massage therapists are finding work there.

Although the true origins of the term Day spa Are somewhat shrouded in mystery, the term is generally attributed to a business woman and spa owner from Connecticut named Noelle DeCaprio. She started her day spa in 1978 and is credited with being the first person to classify her establishment in this manner.

Want to give your Aunt Minnie in Cleveland a spa surprise for her birthday but you don’t know how to set it up? Just call 1-888-SPA-WISH (888-772-9474) and order a gift certificate that’s good for massages, facials, and other treats at nearly 800 day spas across the U. S. And check out the coupon at the back of this book to receive a discount!

Choosing a spa that’s right for you

Spas range from rugged adventure outposts in the desert to the most puffy pampering palaces on the planet. You have almost unlimited choices when you’re deciding where to go, which is great, but the number of choices may also make your decision kind of difficult.

Some spas, such as the Green Valley spa in St. George, Utah, offer rock climbing on the menu right alongside their massages. Some spas expect you to join in on every exhausting 6 a. m. mountain hike they offer. Others leave you alone to steep in herbal baths all day.

So, how do you choose?

First, decide what’s important to you and what you want to accomplish on your spa trip. This can usually be broken down into a few basic categories: fitness, healing, spirituality, relaxation, or some combination of these.

Next, talk to someone who’s been there before, or get the details from a reliable source. Here are three sources that may help you make the right match with a spa:

Get in touch with Spa Finders travel agency and check out their magazine by calling 800-ALL-SPAS (800-255-7727) or visiting Www. spafinders. com.

Pick up the spa travel guide, Fodofs Healthy Escapes (Fodor’s Travel Publications), by Bernard Burt, which lists great spas of all types in many parts of the world.

U* The International SPA Association (ISPA) has a Web site, the Global Spa Guide, at www. gl obal spagui de. com, which may help you find the right place for your spa trip.

Spa Treatments

So what do people actually do at spas all day, other than get massages and douse themselves in crushed grapes? Believe it or not, they are also in pursuit of improved health. Yes, that’s right. And the way they achieve it is to eat spa food, follow a spa exercise program, and receive what are known as Spa treatments, All of which are good for you in one way or another. Spa treatments include:

Scrubs Wraps V* Hydrotherapy Facials

Mud, seaweed, and other messy things

If you don’t want to travel to one of the three types of spas to receive these treatments, you can create them at home for yourself and your family. The advantages of this approach are obvious. First, if you’re like most people, you live right in your own home, so you won’t have to travel far to get there. Also, having your husband or wife or best friend wrap you in herb-infused sheets is a lot cheaper than paying a professional wrapper to do it.

If you’re like most people, a 10-day spa vacation in Maui is a little out of reach, except perhaps as a once-in-a-lifetime dream vacation. But you can still take advantage of your local day spa a few times a year, and create some spa experiences for yourself at home, each and every week. Each type of spa treatment I list below includes a version you can try at home, and, as you can see, they’re not that difficult.

For the following treatments, you need a very specialized piece of equipment. Don’t worry — it’s very inexpensive, and you can find it in the spa department of your local drug store. It looks amazingly like a simple 6-pack cooler, but I call it a Spa thermal unit. Use it to store the hot moist towels that you need to wipe off spa goop from your partner’s body.

Scrubs

During their stay at a spa, many people sign up for an exfoliation, which is a word that comes from that ancient spa language, Latin. It means "to strip away dead leaves." In other words, it’s a fancy name for a body scrub.

Body scrubs are good for you because they slough away dead skin cells, allowing your skin to breathe again and preparing your pores to absorb all those enriching ingredients like massage oils from India and mango bath salts from The Body Shop.

If you don’t have the time or patience to create the entire body scrub experience that follows, try using a pair of Scrub gloves. You can find them in beauty supply stores, drug stores, and gift shops. These textured gloves do the exfoliation for you while you simply rub the skin. No water, soaps, or other ingredients are needed.

Body scrub ingredients

Body scrubs are very easy to do. You need just a few simple ingredients:

Iv* Loofah sponge I> 4 cups of warm water in bowl \^ 4 hot, moist, wrung-out hand towels in an ice chest

Washcloth I> 2 bath towels V Body bath

Exfoliant (1/2 cup sea salt with approximately 3 tablespoons of water and 3 drops of essential oil added)

The exfoliant itself is quite simple. Mix the sea salt with water a little at a time until you have a batter-like consistency, and then add a few drops of your favorite essential oil. Any of the many over-the-counter skin scrubbing products you can buy at the beauty store or department store will work quite nicely, too.

You may not want to do this treatment on your new $800 silk carpet from Turkey, because drips and drops of salt and other ingredients do tend to find their way onto whatever surface you’re using.

Step-by-step body scrub

The following steps show you how to create a body scrub that’s as nice as one you experience at a spa. Just make sure to keep your partner warm because wet bodies cool down fast. You can cover the areas you’re not working on with a towel.

1. With your partner face down on a bath towel, moisten her back and the back of her legs with a washcloth.

2. Place a dab of exfoliant in one palm and use circular movements to scrub your partner’s skin.

3. Use a hot, moist towel from the cooler to wipe off the exfoliant.

4. Dip the loofah sponge in the bowl of water, squeeze a dab of body bath onto it, and then go back over your partner’s skin again with circular movements.

5. Use your second hand towel to wipe the skin.

6. Have your partner turn over and repeat Steps 1-5 on the front of the legs, torso, and arms.

Never use sea salt or body exfoliants on the face. You can purchase exfo-liants made specifically for the face in the cosmetics departments of most major department stores.

7. When you’ve finished exfoliating the front of the body, apply some

Massage lotion to the skin.

You can either do this application of lotion quickly, or you can linger and perform an entire massage, depending upon your mood and your partner’s mood.

8. Have your partner turn over once more, replacing the damp bath towel beneath her with a dry one, and apply skin lotion to her back and the backs of her legs.

9. Touch your partner’s skin (or have somebody else touch it) gingerly, exclaiming, "Ooh, aah, you feel So Smooth!"

Facials

As you may know, the cosmetics industry is big business, with lots of expensive products out there for you to buy, but all you need in order to give yourself or a partner a very nice facial treatment is a little bit of aloe and a ripe papaya. You never knew it could be so easy, did you?

Facial ingredients

You have to have just a few things ready in order to perform a fun and effective facial:

3 hot moist hand towels in your cooler Cotton pads Facial toner

1/2 ripe papaya (no seeds or skin) blended with 1 teaspoon aloe vera gel Skin cream

Step-by-step facial

Follow the steps in this section to create a relaxing, rejuvenating facial.

1. Cleanse the face with skin toner and remove any makeup.

2. Place a hot, moist towel on the face and hold it in place for 2 minutes, allowing the pores to open.

Remember to leave an opening for the mouth and nose if you want your partner to be able to breathe through this procedure.

3. Remove the towel and apply the papaya/aloe blend in a thin smooth layer over the face, using your fingers.

4. Place another hot towel over the face to keep the mixture moist.

5. Massage your partner’s hands while the face is covered.

6. Exchange the towel for a warm one after a few minutes and continue massaging the hands.

7. Remove the towel, wiping off whatever’s left of the papaya/aloe mixture with it.

Using a face cream, do the face massage routine in Chapter 11.

Remember to always stroke upwards when you’re giving a facial, like professional estheticians do, so you won’t pull down on the delicate collagen fibers which give your skin its tone.

Wraps

Some people think that body wraps are only good for losing inches. And certain wraps Can Help you slip into that red dress that’s been hanging for years in the closet. But, as you’ve probably been told (by everyone except the manufacturers of the wraps), what you’re really losing is water weight, which will, unfortunately, come back.

Serious health spas use wraps that detoxify the body, usually known as Herbal wraps. And they work by tricking your body into thinking it has a fever, causing it to purge itself of internal toxins. While working as a wrapper at big spas, I used to routinely unwrap people and find the sheets permeated with the smell of nicotine and other products that the client’s body was purging.

Other types of wraps, like aromatherapy ones, for example, are available, but my favorite is the herbal wrap, because it is the most deeply detoxifying, so that’s the one I describe for you here.

This treatment is a bit more involved than the others, so only attempt it if you’re in a truly experimental mode and want to learn by trial and error.

Herbal utrap ingredients

Get ready for a fun production in your kitchen as you prepare the herbal wrap, and don’t be discouraged if the wrap is not as warm as you’d like the first time you try. This treatment takes a little practice to do well.

3 ounces of herbs — the fresher the better (Try a combination of chamomile, rosemary, lemongrass, and eucalyptus.)

\^ A little bag or piece of cheese cloth in which to tie up the herbs for soaking (Even a clean sock will do in a pinch.)

A sheet for soaking and wrapping

^ A big pot to heat water in and make the herbal solution

A pair of rubber gloves handy so you don’t scald your fingers

A rubberized sheet, or space blanket, or piece of plastic (like a drop cloth)

A wool blanket

Herbal ulrap step-by-step

Follow these steps to create a do-it-yourself herbal wrap similar to the type given at great luxury spas.

1. Place the herbs in the cloth, basically creating a big tea bag, and drop it in a big pot of hot (not boiling) water.

Maximum temperature should only be around 165 degrees Fahrenheit. Soak the herbs 20 minutes. Then add the sheet to the pot of hot tea and let it soak for a few minutes.

2. While the sheet is soaking in the herbal tea, lay the wool blanket down, then place the plastic or rubberized sheet on top of it.

3. Wring the sheet out Very well, Remembering to wear your rubber gloves.

Lay the sheet down on top of the plastic and have your partner lie down on it. In order to make the herbal wrap work best, have your partner sit in a hot bath, Jacuzzi, or sauna before getting wrapped.

4. Wrap around your partner the hot sheet, then the plastic wrap, and then the wool blanket.

5. Make sure your partner is comfortable.

You can put something beneath his knees and head for support, if desired, and give him a sip of cool water through a straw. Leave him wrapped for about 20 minutes, keeping an eye on him. And, if he asks, scratch his nose for him (wrapped people often complain of itchy noses).

6. When you unwrap him, give him some more water and help him sit in a comfortable chair where he can relax for another 20 minutes, letting the herbs dry naturally on his skin.

Hydrotherapy

Hydrotherapy Is a word that means, obviously, therapy with fire hydrants. Just kidding… but that description is actually quite close to the truth. Would you believe, for example, that people pay good money in spas to stand naked against a tile wall while a hydrotherapy expert sprays a blast of cold water at them from a pressure hose? It’s true (this is called a Scotch Hose treatment).

Hydrotherapy treatments in luxury spas can also involve the use of super-expensive Hydrotherapy tubs, Which look like a cross between a bathtub and a Jacuzzi. You don’t need to be in one of these tubs to experience hydrotherapy. In fact, your own bathtub or shower at home will do just fine.

Here are a few ideas for taking advantage of your own water source to do a little hydrotherapy at home:

Bathe someone. For most of us, the last time we were bathed was in early childhood by our mothers, and we’ve forgotten how soothing it is. Using a pitcher, pour warm water over your partner’s head, shoulders, and back in the bath. Then wash her slowly and luxuriously.

J> Take a cold plunge. Many spas have what’s known as a cold plunge, which is a pool kept at a shockingly low temperature. Patrons jump in after being heated up in saunas and whirlpools. You can simulate the extremely invigorating effects of this activity by drawing a cold bath and immersing yourself for 30 seconds (or as long as you can stand it).

Share a bath with a friend. First, make sure the friend wants to share the bath with you. After you determine that, slip into a tub of warm water with 10 drops of aromatherapy oil added, and see what happens next. It may not be entirely therapeutic, but it certainly will be fun.

Exercise… a day of pleasure

The spa lifestyle is for everyone — unless you’re the type who disdains pleasure and health, like the flagellant monks of the Middle Ages, for example, who used to wander around the streets beating themselves with sticks. If that’s your idea of fun, definitely stay away from anything to do with spas.

If, on the other hand, you have what it takes to treat yourself to some healthy enjoyment in life, why not plan an entire day of spa pleasures? The sultans used to do it, and so did Cleopatra with rose petals a foot thick on the floor of her love chamber. But how about you?

You can recreate a day of luxury just like the ones people experience at spas. Trade each treatment with a lucky partner and spend the day together. Then go out and celebrate your indulgence with a healthy meal at a restaurant.

The whole exchange (not including dinner) takes about 5 hours. Just follow these simple

IBB

1. First, start with a body scrub to cleanse the skin and prepare you to absorb the healthy effects of the oils and other ingredients to follow.

2. Take turns soaking in a bath (or soak together if you’re so inclined), with a dozen drops of your favorite aromatherapy oil or a few ounces of healing herbs added.

3. Exchange long luxurious massages, following along with the step-by-step instructions in Chapter 11

4. Give each other a spa facial to prepare yourselves for reentry into the world.

Mud, seaweed, and other messy things

Other kinds of spa treatments work, too, but I don’t go into them here, because if you tried them at home you may mess up your furniture or carpet. These treatments involve the use of such products as mud, seaweed, and clay — and they can be really messy! If you do experiment with these products (many of which are available at cosmetics counters and in beauty supply stores), try to confine your activities to the bathroom, where you’re less likely to stain things.

Massage-O-Matic Specialty Stores

When you’re searching for items to create your own spa or massage environment at home, try checking out a new type of outlet known as the Massage specialty store. Until recently, this type of store didn’t even exist, but now they’re popping up in many locations. If you ever find yourself near one of them, you really should pay a visit, because they’re quite cool. And don’t be intimidated by the New Age feel at some of these places. Everyone is allowed inside, not just crystal-toting members of the massage avant-garde.

Three basic types of massage-oriented storefronts exist:

■ Manufacturers’ outlets I V Ergonomic specialists 1 W Massage-o-matics

Manufacturers’ outlets

Some of the companies that manufacture equipment such as tables and chairs for massage pros have also begun experimenting with selling their wares directly to the public. These companies are still concentrated in that global hotbed of massage innovation, California, although they exist elsewhere as well. Their number will grow quickly as these items become more popular, and in the meantime you can find some quality massage products in a number of other stores, too, such as the Sharper Image. (See the "Massage Gizmos" section in Chapter 10, which explains the use of many massage devices.)

Check these massage stores out, if you have the opportunity:

The Massage Company:

• 1714 Lombard Street, San Francisco, CA 94105 (telephone: 415-346-7828)

• 1533 Shattuck Ave, Suite A, Berkley, CA 94709 (telephone: 510-704-2970)

V Bodywork Emporium:

Call 800-TABLE-4-U (800-822-5348 or 310-394-4475 extension 14) for a free, | 48-page catalogue

Massage Central:

12235 Santa Monica Boulevard, Los Angeles, CA 90025 (telephone: 310-826-2209)

New Life Massage Equipment:

2853 Hedberg Drive, Minnetonka, MN 55305 (telephone: 800-852-3082 or 612-546-4100)

J** Best of Nature:

176 Broadway, Long Branch, NJ 07740 (telephone: 800-228-6457, or 732-728-0004)

You can find a lot of massage equipment on the Web as well. Go to www. mtswa rehouse. com, for example, to find good prices on professional massage tables, and www. massagematters. com for a few, select, high-quality massage items.

Ergonomic specialists

Some stores are not primarily massage outlets, but they do offer massage items and other tools that make our working and living environments more ergonomically correct. Ergonomics Is a fancy term for the science concerned with designing and arranging things (like pieces of furniture) so that people interact with them most efficiently and safely.

One store in particular, Relax the Back, has created the mother lode of ergonomically designed furniture to help you prevent injuries and keep you healthy. It also sells several massage items that you can choose from. The philosophy of Relax the Back is that an ounce of prevention is worth a pound of cure. Call 800-290-2225 to find a store near you, or look them up at www. rel axtheback. com on the Web.

Mas$aqe~o~matics

Believe it or not, places exist where you can just pop in off the street and get your back rubbed for ten minutes. This kiosk take on the massage phenomenon is ideal for people traveling through airports or rushing through big cities. Here are a couple of examples:

U* The Great American Back Rub (800-BACK-RUB or 800-222-5782): This company has stores in New York City; Kennedy Airport (New York, New York); Dallas, Texas; Toronto, Canada; and Los Angeles, California — and it’s always looking to expand.

The Stress Station: This company has two locations in the Phoenix, Arizona, area, one in Scottsdale (480-990-1701), and one in Paradise Valley (602-692-9004), with plans to expand. It also provides outcall massage to your location.

In some areas, you may find independent massage practitioners who’ve set up shop on their own or in small groups in public places such as Central Park in New York City, The Champs-Elysees in Paris, or the beach in Bali or Southern Thailand. Approaching these people for a massage-o-matic experience is perfectly safe. Just follow the same words of advice found in Chapter 7 that you’d heed when receiving any kind of massage, especially the one that tells you to remember that "You’re the boss." Declaring what kind of massage you want to receive from these public practitioners is perfectly acceptable, even if the massage only lasts five minutes. Don’t let an overly enthusiastic street masseur pound your back until it’s black and blue.

I?30 ^art ^: ‘-’v'n9 *e ^00(‘ Massage f°r Every Body

Chapter 16