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Introduction

"Kate" is a thin, attractive 50-year-old perimenopausal woman who considers herself "basically healthy" but feels she needs help with stress management in her life. She is educated, married, and the mother of 4 children ranging in age from 11 to 22 years. In addition to managing her household,she has a full-time job as an administrative assistant and also works a part-time job from home. She states she needs to do this so the family can "get back on our feet" asher husband was unemployed for a number of months and they currently have 2 children in college. In addition,they relocated a year ago to Pittsburgh, Pennsylvania, for her husband’s job and now have a higher mortgage payment.

"Family" is Kate’s top priority, but she does not receive much assistance from her husband on the home front and feels "there is not enough time in a day." Family members outside the home are supportive (as she is of them); however, her closest family member lives about 7hours away. She visits family on most holidays but also has the additional burden of needing to come back to the area often since her father has been ill and will require major cardiac surgery at Yale. She has made new friends in Pittsburgh and occasionally engages in a "girls’ night out."Otherwise, she tends to shuttle the 2 younger children to events, friends’ houses, etc.

Many days she finds herself feeling "frazzled" and is currently experiencing anxiety, fatigue, sleep disruption, occasional "mental fogginess," palpitations, and an increase in mitral valve pro lapse (MVP) symptoms. "Self regulation" is minimal, with no regular practice except for aerobic exercise. Family vacations are taken twice a year,totaling 2 to 3 weeks.