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Chest Pain From Yawning: Understanding the Causes and When to Seek Help
Introduction:
Ever experienced a sharp, stabbing pain in your chest when you yawn? It's a startling sensation that can leave you wondering what's going on. While sometimes harmless, chest pain from yawning can also signal underlying medical conditions requiring immediate attention. This comprehensive guide delves into the possible causes of this discomfort, explores when it's a cause for concern, and offers advice on when to seek professional medical help. We'll unravel the mystery behind this perplexing symptom, providing you with the knowledge to understand your body and make informed decisions about your health.
1. Understanding the Mechanics of Yawning and Chest Pain
Yawning is a complex reflex involving the deep inhalation of air, stretching of the lungs and chest muscles, and a subsequent exhalation. This expansion of the chest cavity can exacerbate existing conditions or put pressure on sensitive areas, leading to pain. The intensity and location of the pain can vary greatly, from a mild ache to a sharp, stabbing sensation. Understanding the mechanics of yawning helps us understand why certain underlying conditions might manifest as chest pain during this seemingly innocuous act. The increased pressure within the chest cavity can affect structures such as the ribs, muscles, and even the heart and lungs.
2. Common Causes of Chest Pain During Yawning:
Several relatively benign conditions can trigger chest pain during yawning:
Musculoskeletal Issues: Muscle strains or inflammation in the chest wall, ribs, or surrounding muscles (costochondritis, for example) can be aggravated by the stretching associated with yawning. This is often characterized by localized pain that worsens with deep breaths or movement.
Costochondritis: This condition causes inflammation of the cartilage connecting the ribs to the breastbone (sternum). The stretching of this cartilage during a yawn can lead to significant pain.
Rib Subluxation: A slightly dislocated rib can cause sharp, localized pain, especially during activities that involve deep breathing or chest expansion, such as yawning.
Pleurisy: Inflammation of the pleura (the lining of the lungs and chest cavity) can cause sharp, stabbing pain worsened by breathing deeply, coughing, or yawning.
Anxiety and Panic Attacks: While not directly causing physical damage, anxiety and panic attacks can manifest as chest pain, shortness of breath, and other symptoms. The act of yawning might intensify these sensations.
3. Serious Conditions Associated with Chest Pain from Yawning:
While many cases of chest pain during yawning are benign, some serious medical conditions can also present with this symptom. It's crucial to seek immediate medical attention if chest pain is accompanied by any of the following:
Heart Conditions: Conditions like angina (chest pain due to reduced blood flow to the heart) or a heart attack can cause chest pain that may be exacerbated by yawning. Other symptoms such as shortness of breath, sweating, nausea, and dizziness should prompt immediate medical evaluation.
Pulmonary Embolism: A blood clot in the lungs can cause sudden, sharp chest pain, often worsened by deep breathing. This is a life-threatening emergency requiring immediate medical attention.
Pericarditis: Inflammation of the pericardium (the sac surrounding the heart) can cause chest pain that is often sharp and worsened by breathing deeply or lying down.
Aortic Dissection: A tear in the aorta (the main artery leaving the heart) is a life-threatening condition that can cause sudden, severe chest pain that radiates to the back. This requires immediate emergency medical care.
4. When to Seek Immediate Medical Attention:
Chest pain during yawning, while often benign, should never be ignored. Seek immediate medical attention if:
The pain is severe, sudden, or crushing.
The pain radiates to your arm, jaw, neck, or back.
You experience shortness of breath, dizziness, sweating, or nausea.
The pain is accompanied by a rapid or irregular heartbeat.
The pain lasts for more than a few minutes.
You have a history of heart disease or other serious medical conditions.
5. Diagnosis and Treatment:
A doctor will conduct a thorough physical examination and may order various tests to diagnose the cause of your chest pain, including:
Electrocardiogram (ECG): Measures the electrical activity of your heart.
Chest X-ray: Provides images of your lungs and heart.
Echocardiogram: Uses ultrasound to create images of your heart.
Blood tests: May be used to rule out infections or other conditions.
CT scan or MRI: May be used to visualize the structures of your chest in more detail.
Treatment will depend on the underlying cause of your chest pain. This could range from rest and over-the-counter pain relievers for musculoskeletal issues to surgery for more serious conditions.
Article Outline: Chest Pain From Yawning
Name: Understanding and Addressing Chest Pain Triggered by Yawning
Introduction: Hooking the reader with a relatable experience and outlining the article's purpose.
Chapter 1: Mechanics of Yawning and its Impact on the Chest.
Chapter 2: Benign Causes of Yawning-Related Chest Pain (Musculoskeletal issues, Costochondritis, etc.).
Chapter 3: Serious Medical Conditions Associated with Yawning-Induced Chest Pain (Heart conditions, Pulmonary Embolism, etc.).
Chapter 4: When to Seek Immediate Medical Attention: Warning signs and symptoms.
Chapter 5: Diagnosis and Treatment Options: Tests and potential treatment plans.
Conclusion: Recap of key points and emphasis on seeking professional help when necessary.
(The content above largely fulfills the outline.)
9 Unique FAQs:
1. Can stress cause chest pain when yawning? Yes, anxiety and panic attacks can manifest as chest pain, potentially worsened by the deep breaths of a yawn.
2. Is chest pain from yawning always serious? No, often it’s due to benign musculoskeletal issues. However, serious conditions are possible.
3. What are the symptoms of a heart attack related to yawning? Crushing chest pain, radiating pain, shortness of breath, sweating, nausea, dizziness.
4. How is chest pain from yawning diagnosed? Through physical examination, ECG, chest X-ray, blood tests, and possibly imaging studies like CT or MRI.
5. What home remedies can help with chest pain from yawning? Rest, gentle stretching, over-the-counter pain relievers (like ibuprofen or acetaminophen), applying heat or ice. (Note: This is not medical advice; consult a doctor.)
6. Can yawning cause rib pain? Yes, muscle strains or rib subluxations can cause pain aggravated by the chest expansion during yawning.
7. Should I avoid yawning if I have chest pain? Not necessarily, but be mindful. If yawning triggers pain, try to yawn gently. Severe pain warrants medical attention.
8. How long does chest pain from yawning usually last? It depends on the cause. Benign causes might resolve quickly, while serious conditions require immediate medical intervention.
9. Can I prevent chest pain from yawning? Addressing underlying conditions like muscle strains is crucial. Gentle stretching and stress management techniques may help.
9 Related Articles:
1. Costochondritis Treatment and Management: A detailed guide on managing and treating this common cause of chest pain.
2. Understanding Angina and its Symptoms: A comprehensive overview of angina pectoris and its connection to chest pain.
3. Pulmonary Embolism: Recognizing the Signs and Seeking Help: Information on recognizing the symptoms of this life-threatening condition.
4. Anxiety and Chest Pain: The Mind-Body Connection: Exploring the relationship between anxiety and chest pain.
5. Rib Subluxation: Causes, Symptoms, and Treatment: A guide to understanding and managing rib subluxations.
6. Pleurisy: Diagnosis, Treatment, and Prevention: Information on pleurisy, its causes, and treatment options.
7. Heart Attack Symptoms in Women: Highlighting the unique symptoms of heart attacks in women.
8. Aortic Dissection: A Medical Emergency: A comprehensive guide on aortic dissection, its symptoms, and emergency treatment.
9. Managing Chest Pain at Home: When to Seek Medical Care: Advice on managing mild chest pain at home and when it's necessary to seek professional medical help.
| chest pain from yawning: The Mystery of Yawning in Physiology and Disease Olivier Walusinski, 2010-01-01 Yawning is a stereotyped phylogenetically ancient phenomenon that occurs in almost all vertebrates. As an emotional behavior and an expressive movement, yawning has many consequences; nevertheless, it has so far been poorly addressed in medical research and practice. Bringing together the latest research from many fields, this volume integrates current insights within embryology, ethology, neurophysiology, psychology, fMRI and pathology. The phylogenetic and ontogenetic aspects of yawning offer an interesting perspective on human development, and its occurrence in neurological diseases - an area explored by only a few investigators - may provide useful clinical information. This book will make valuable and fascinating reading to neurologists, sleep specialists, psychologists, ethologists and pharmacologists, as well as to anybody interested in uncovering the mystery of yawning. |
| chest pain from yawning: Pericardial Disease J. Soler-Soler, G. Permanyer, J. Sagristà-Sauleda, 2012-12-06 In November 1986, I was invited to attend a symposium held in Barcelona on Diseases of the Pericardium. The course was directed by Dr. J. Soler-Soler, director of Cardiology at Hospital General Vall d'Hebron in Barcelona. During my brief but delightful visit to this institution, my appreciation of the depth and breadth of study into pericardial diseases, carried out by Dr. Soler and his group, grew into the conviction that these clinical investigators have accumulated a wealth of information concerning pericardial diseases, and that investigators and clinicians practicing in English speaking countries would greatly profit from ready access to the results of the clinical investiga tions into pericardial disease carried out in Barcelona. The proceedings of the Barcelona conference were published in a beauti fully executed volume in the Spanish language edited by Dr. Soler and pro duced by Ediciones Doyma. Because I believe that this work should be brought to the attention of the English speaking scientific and clinical com munities, I encouraged Dr. Soler to have the book translated into English. I knew that this task could be accomplished and that the book would be trans lated into good English without change of its content. My confidence was based upon a translation of my own book, The Pericardium, into Spanish undertaken by Dr. Permanyer, who is a contributor and co-editor of the pre sent volume. |
| chest pain from yawning: On Intermittent Fever and Other Malarious Diseases Israel Shipman Pelton Lord, 1871 |
| chest pain from yawning: Bonica's Management of Pain Scott M. Fishman, 2012-03-29 Now in its Fourth Edition, with a brand-new editorial team, Bonica's Management of Pain will be the leading textbook and clinical reference in the field of pain medicine. An international group of the foremost experts provides comprehensive, current, clinically oriented coverage of the entire field. The contributors describe contemporary clinical practice and summarize the evidence that guides clinical practice. Major sections cover basic considerations; economic, political, legal, and ethical considerations; evaluation of the patient with pain; specific painful conditions; methods for symptomatic control; and provision of pain treatment in a variety of clinical settings. |
| chest pain from yawning: A Cyclopaedia of Drug Pathogenesy , 1888 |
| chest pain from yawning: On Intermittent Fever I. Lord, 2023-04-12 Reprint of the original, first published in 1871. The publishing house Anatiposi publishes historical books as reprints. Due to their age, these books may have missing pages or inferior quality. Our aim is to preserve these books and make them available to the public so that they do not get lost. |
| chest pain from yawning: The Guiding Symptoms of Our Materia Medica Constantine Hering, 2005 |
| chest pain from yawning: The United States Journal of Homœopathy , 1860 |
| chest pain from yawning: The American Journal of Homœopathic Materia Medica , 1869 |
| chest pain from yawning: Condensed Materia Medica Constantine Hering, Augustus Korndoerfer, Ernest Albert Farrington, 1877 |
| chest pain from yawning: The Encyclopedia of Pure Materia Medica Timothy Field Allen, 1876 |
| chest pain from yawning: Manual of Homœopathic Medicine ... Gottlieb Heinrich Georg Jahr, 1847 |
| chest pain from yawning: Our Family Physician Henry Rice Stout, 1887 |
| chest pain from yawning: The Importance of Acknowledging Childhood Trauma in the Clinical Field Rita Ballantyne, 2024-05-23 There is a distinct lack of discussion pertaining to the lasting damage narcissistic parents inflict on their children, a shortfall so intense that some of the victims themselves don't recognise the harm done to them either, or accept the abuse as being their fault. One of the saddest things is that most children or grown-up survivors never get help or relate their lifelong relationship troubles back to their real origins. They are often categorised by society as having only suffered emotional abuse at best. It is disappointing how lots of professionals and, in particular, physicians and counsellors, minimise the pain those who have lived through lasting emotional trauma are feeling and the impact it has on the patients' physical and psychological well-being. Don't judge and condemn what you don't understand. By taking the reader through my own personal journey dealing with this kind of abuse, I aim to present how detrimental emotional abuse can be and try to bridge that above mentioned gap in general knowledge. |
| chest pain from yawning: Manual of Homœopathic Medicine; translated from the third edition, ... by J. Laurie; with a preface by P. Curie Gottlieb Heinrich Georg JAHR, 1847 |
| chest pain from yawning: The British Journal of Homoeopathy , 1860 |
| chest pain from yawning: Differential Diagnosis of Chest Pain Umashankar Lakshmanadoss, 2020-07-01 This book aims to provide an excellent overview of the differential diagnosis and approach to chest pain in various clinical settings. This book is divided into two sections including the introduction and the approach to chest pain. Our introductory chapter starts with the basic principles of statistics and its application in various diagnostic modalities of heart disease. Our authors present a nice approach to patients presenting with chest pain in various scenarios. We have also included a chapter describing GERD, which could present as chest pain and another chapter describing aortic dissection, which is a life-threatening disease presenting with chest pain. We hope that this book will serve as an accessible handbook on the differential diagnosis of chest pain. |
| chest pain from yawning: Hyperventilation Syndrome (Rev Ed) Dinah Bradley, 2012-02-03 The expert guide to a range health issues caused by poor breathing. Do you sometimes experience panicky feelings for no apparent reason? Do you experience tingling sensations in your lips or fingertips - or both? Do you frequently feel 'spaced out' or find it hard to concentrate at work? Do you sometimes feel breathless for no apparent reason? Have you ever been accused of being a hypochondriac? Has your self-confidence taken a nose dive? If so, you are not alone. 12% of the population suffers from hyperventilation syndrome in varying degrees and experience distressing fears along with the puzzling array of symptoms that accompany bad breathing. This new expanded and updated edition of this classic book contains a workbook section to help the reader identify how their stress levels, sleep and symptom patterns interrelate with each other. Also included are a number of personal stories from people who have been identified as chronic hyperventilators and who have overcome the problems by using the drug-free methods outlined in this book. |
| chest pain from yawning: Acute Exposure Guideline Levels for Selected Airborne Chemicals National Research Council, Board on Environmental Studies and Toxicology, Committee on Toxicology, Committee on Acute Exposure Guideline Levels, 2010-03-18 This book is the eighth volume in the series Acute Exposure Guideline Levels for Selected Airborne Chemicals, and reviews AEGLs for acrolein, carbon monoxide, 1,2-dichloroethene, ethylenimine, fluorine, hydrazine, peracetic acid, propylenimine, and sulfur dioxide for scientific accuracy, completeness, and consistency with the NRC guideline reports. |
| chest pain from yawning: The Encyclopedia of Pure Materia Medica T. F. Allen, 1997 A complete guide of materia medica, that gives an accurate record of experiments made upon healthy individuals to ascertain the effects of drugs. |
| chest pain from yawning: A Treatise on the Small-pox and Measles Rhazes, 1848 |
| chest pain from yawning: Complete Guide to Respiratory Care in Athletes John Dickinson, James Hull, 2020-07-21 Complete Guide to Respiratory Care in Athletes introduces the respiratory system and its function during exercise. It considers the main respiratory conditions affecting athletes and delivers practical advice for the management of respiratory issues in athletic populations. With contributions from leading international experts, the book discusses fundamental scientific principles and provides pragmatic ‘hands-on’ clinical guidance to enable practical application. Each chapter includes useful pedagogical features such as case studies and guides for carrying out assessments. The book covers wide a range of topics, including: respiratory system function during exercise impact of the environment on the upper and lower airways asthma related issues in athletes allergic rhinitis in athletes exercise induced laryngeal obstruction exercise induced dysfunctional breathing paterns respiratory muscle training role of screening for respiratory issues in athletes assessing and dealing with respiratory infections in athletes. This text is key reading for both newly qualified and established medical, scientific and therapy practitioners who are working with athletes with respiratory issues. It is also a valuable resource for students of sports medicine, sports therapy, and sport and exercise science courses. |
| chest pain from yawning: The Homeopathic Examiner John F. Gray, Charles J. Hempel, Amos Gerald Hull, 1840 |
| chest pain from yawning: A dictionary of practical materia medica John Henry Clarke, 1997 |
| chest pain from yawning: The Foundations of Chinese Medicine Giovanni Maciocia, 2015-07-13 The latest edition of this hugely popular volume continues to provide readers in the West with a clear explanation of the theory and practice of Chinese medicine. Richly illustrated and fully updated throughout, Foundations of Chinese Medicine retains its careful structure to present the subject in a systemized manner which ranges from first principles to the diagnosis and management of a wide range of disease states. NOW WITH AN ACCOMPANYING WEBSITE containing an extensive bank of review and test material, the latest edition of this important volume has been redesigned to provide a more accessible, up-to-date feel to the content to enhance the reader?s learning experience. Offering a unique combination of rigorous scholarship together with a wealth of clinical experience, Maciocia?s Foundations of Chinese Medicine will be ideal for all students of Chinese medicine, acupuncture and Chinese herbal medicine as well as qualified practitioners needing to stay up-to-date with changes in the field. For the student or practitioner of Chinese medicine this is a definitive text book. Reviewed by Jim Young on behalf of glycosmedia.com, Aug 2015 25th Anniversary edition of the Western world's best-selling book on Chinese medicine! Logical, sequential organization builds from basic theoretical concepts, through functions of individual organs, diagnosis, pathology, pattern recognition & disease categories, and the appropriate use of acupuncture points Clearly explains the theory and practice of Chinese Medicine to Western medical audiences Based on a unique and invaluable combination of extensive clinical experience in the West, current Chinese Medicine textbooks and ancient sources, in particular, the 'Yellow Emperor's Classic of Internal Medicine' (Nei Jing) and the 'Classic of Difficulties' (Nan Jing) Includes Pinyin equivalents to make it immediately evident which original term is being translated Abundantly illustrated with over 750 line drawings and more than 1000 tables & boxes designed to emphasize the key facts End of chapter Learning Outcomes point out 'must-know' information Cases Studies and Case Histories apply theory to diagnosis and treatment, bringing the subject to life in a realistic context An extensive Glossary explains new terms and their origins from translation Additional Appendices list Prescriptions, Bibliography and Chinese Chronology Authored by Giovanni Maciocia, one of the Western world's leading subject matter experts An accompanying EVOLVE website provides over 650 self-testing questions and answers to help readers check their understanding of frequently complex information New Case Histories help 'bring the subject to life' Expanded subject area coverage including new clinical guidelines and additional acupuncture point combinations Contains further analysis of acupuncture point actions Innovative guidelines aid students learning Chinese Medicine patterns |
| chest pain from yawning: Materia medica Constantine Hering, 1873 |
| chest pain from yawning: C. Herring's Materia Medica with a Pathological Index Constantine Hering, 1873 |
| chest pain from yawning: A Cyclopaedia of drug pathogenesy v. 1, 1886 , 1886 |
| chest pain from yawning: Differential Diagnosis in Pediatrics Suraj Gupte, 2019-07-31 This new edition provides paediatricians with the latest developments in the diagnosis of diseases and disorders in children. Divided into five sections, the book begins with a colour atlas illustrating different signs and symptoms. The following chapters describe numerous common paediatric presentations with guidance on differential diagnosis. The book concludes with sections on differential diagnosis of select clinical signs, salient laboratory findings, and select radiologic signs. The sixth edition has been fully revised and features new topics including micrognathia, Potter’s face syndrome, mediastinal shift, and more. Key points Guide to latest developments in differential diagnosis of paediatric diseases and disorders Fully revised, sixth edition featuring several new topics Includes comprehensive colour atlas illustrating different signs and symptoms Previous edition (9788184487275) published in 2008 |
| chest pain from yawning: Jahr's new manual, (or Symptomen-codex.) Gottlieb Heinrich Georg Jahr, 1853 |
| chest pain from yawning: Materia medica , 1884 |
| chest pain from yawning: Materia Medica: Physiological and Applied , 1884 |
| chest pain from yawning: Nelson Pediatric Symptom-Based Diagnosis E-Book Robert Kliegman, Heather Toth, Brett J. Bordini, Donald Basel, 2022-01-10 Patients don't present with a disease; they present with symptoms. Using a practical, symptom-based organization, Nelson Pediatric Symptom-Based Diagnosis: Common Diseases and their Mimics, 2nd Edition, offers authoritative guidance on differential diagnosis and treatment of diseases and disorders in children and adolescents, and covers the symptoms you're likely to see in practice, their mimics, and uncommon disorders. Drs. Robert M. Kliegman, Heather Toth, Brett J. Bordini, and Donald Basel walk you through what to consider and how to proceed when faced with common symptoms such as cough, fever, headache, autistic-like behaviors, chronic pain, chest pain, gait disturbances, and much more. - Begins with a presenting symptom and leads you through differential diagnosis and a concise review of treatment recommendations. - Contains more than a dozen new topics including Disease Mimics: An Approach to Undiagnosed Diseases, Autistic-like Behaviors, Shock, Hypertension, Neurocognitive and Developmental Regression, Chronic Pain, Hypertonicity, Movement Disorders, Hypermobility, and more. - Features a new focus on symptoms of rarer diseases that are mimics of more common diseases. - Offers a user-friendly approach to Altered Mental Status such as coma and other CNS disorders, with numerous clinically useful tables and figures to guide clinical decision making in various care settings. - Uses a highly templated format for easy reference and quick answers to clinical questions, with the same consistent presentation in each chapter: History, Physical Examination, Diagnosis (including laboratory tests), Imaging, Diagnosis, and Treatment. - Includes numerous full-color illustrations, algorithms, tables, and red flags to aid differential diagnosis. - Serves as an ideal companion to Nelson Textbook of Pediatrics, 21st Edition. Content in this book is referenced and linked electronically to the larger text, providing easy access to full background and evidence-based treatment and management content when you own both references. |
| chest pain from yawning: Herings Guiding Symptoms of Our Materia Medica (5 Volumes Set) Constantine Hering, 2023-11-21 Rearranged augmented edition Hearings Guiding Symptoms of Materia Medica |
| chest pain from yawning: Boenninghausen's Characteristics Materia Medica & Repertory with Word Index C. M. Boger, 2002-08 A Condensation Of All Boenninghausen S Work.The Repertory Section Contains The Pocket Book, The Psoric And Antipsoric Repertories, The Repertory Part Of Intermittent Fever, And The Sides Of The Body. |
| chest pain from yawning: The Guiding Symptoms of Our Materia Medica Constantine Hering, 1888 |
| chest pain from yawning: Special pathology and diagnostics Charles Godlove Raue, 1885 |
| chest pain from yawning: Special Pathology and Diagnostics with Therapeutic Hints Charles Godlove Raue, 1896 |
| chest pain from yawning: Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Institute of Medicine, Board on the Health of Select Populations, Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, 2015-03-16 Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are serious, debilitating conditions that affect millions of people in the United States and around the world. ME/CFS can cause significant impairment and disability. Despite substantial efforts by researchers to better understand ME/CFS, there is no known cause or effective treatment. Diagnosing the disease remains a challenge, and patients often struggle with their illness for years before an identification is made. Some health care providers have been skeptical about the serious physiological - rather than psychological - nature of the illness. Once diagnosed, patients often complain of receiving hostility from their health care provider as well as being subjected to treatment strategies that exacerbate their symptoms. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome proposes new diagnostic clinical criteria for ME/CFS and a new term for the illness - systemic exertion intolerance disease(SEID). According to this report, the term myalgic encephalomyelitis does not accurately describe this illness, and the term chronic fatigue syndrome can result in trivialization and stigmatization for patients afflicted with this illness. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome stresses that SEID is a medical - not a psychiatric or psychological - illness. This report lists the major symptoms of SEID and recommends a diagnostic process.One of the report's most important conclusions is that a thorough history, physical examination, and targeted work-up are necessary and often sufficient for diagnosis. The new criteria will allow a large percentage of undiagnosed patients to receive an accurate diagnosis and appropriate care. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome will be a valuable resource to promote the prompt diagnosis of patients with this complex, multisystem, and often devastating disorder; enhance public understanding; and provide a firm foundation for future improvements in diagnosis and treatment. |
| chest pain from yawning: Solution-Focused Therapy Dr Alasdair Macdonald, 2007-03-16 Solution-Focused Therapy is a relatively new, but strongly supported and growing approach. Solution-Focused Therapy: Theory, Research & Practice contains an overview of current research in the area and an account of the use of solution-focused approaches in various relevant therapeutic situations. Written by Dr. Alasdair J. MacDonald, one of the leading Solution-Focused Therapy specialists in Europe and a key figure in the European Brief Therapy Association, this book provides both trainees and practitioners with instruction in the method of solution-focused brief therapy. |
