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15 Aug

Stress management and exercise training in cardiac patients with myocardial ischemia: effects on prognosis and evaluation of mechanisms.

A placebo controlled, randomized study by J.A. Blumenthal et al, published in the Archives of Internal Medicine, 1997; 157: 2213-2223, (called Stress Management and Exercise Training in Cardiac Patients with Myocardial Ischemia: Effects on Prognosis and Evaluation of Mechanisms) showed that teaching stress reduction techniques to cardiac patients reduced their risk of having further heart problems by a whopping 75%. Of 107 patients, 40 received standard medical care; 34 additionally engaged in vigorous exercise for 35 minutes, 3 times a week for 16 weeks; and 33 additionally were given weekly group sessions where they learned relaxation and stress reduction techniques (education, progressive muscle relaxation, biofeedback, thought-stopping, anger management). Results: 30% of the standard care group had additional heart problems; 21% in the exercise group; and only 10% in the stress management group.

Citation: Blumenthal JA, et al. Stress management and exercise training in cardiac patients with myocardial ischemia: effects on prognosis and evaluation of mechanisms. Archives of Internal Medicine. 1997(157):2213-2223.

15 Aug

Williams, Kolar, Reger and Pearson from the Department of Community Medicine, West Virginia University, ran clinical trials to see whether an 8-week, group-facilitated, Jon Kabat-Zinn-styled, Mindfulness-Based Stress Reduction Program could decrease daily stress and medical symptoms in 103 adults. (See our Practitioners We Love page for more about Jon K-Z.)

15 Aug

A controlled pilot study of stress management training of elderly patients with congestive heart failure.

Researchers at the Stanford Center for Research in Disease Prevention evaluated the effects of stress management on the quality of life, functional capacity, and heart rate variability in a pilot study of 33 elderly patients with New York Heart Association class I-III congestive heart failure. Subjects were randomized to one of two treatment groups or a wait-listed control group. The 14 participants who completed the treatment attended eight training sessions during a 10-week period. The training consisted of 75-minute sessions adapted from the Freeze-Frame stress management program developed by the Institute of HeartMath. (This is a very simple and easy to use formula for stress relief, using relaxation and imagery.) Subjects were assessed at baseline and again at the completion of the training. Depression, stress management, optimism, anxiety, emotional distress, and functional capacity were evaluated, as well as heart rate variability. Significant improvements (p<0.05) were noted in perceived stress, emotional distress, 6-minute walk, and depression, and positive trends were noted in each of the other psychosocial measures. The 24-hour heart rate variability showed no significant changes in autonomic tone. The authors noted that CHF patients were willing study participants and their emotional coping and functional capacity were enhanced. They concluded that this program offered a simple and cost-effective way to augment medical management of CHF. Given the incompleteness of CHF medical management and the exploding interest in complementary medical intervention, they recommended that further work in psychosocial treatment be undertaken.

Citation: Luskin F, Reitz M, Newell K, Quinn TG, Haskell W. A controlled pilot study of stress management training of elderly patients with congestive heart failure. Preventive Cardiology 2002 Fall; Issue 5 (Volume 4): pp. 168-72.

15 Aug

Cognitive behavioral stress management effects on injury and illness among competitive athletes: a randomized clinical trial.

In previous research, cognitive behavioral stress management (CBSM) has been found to reduce fatigue, depression, and cortisol response to heavy exercise training among competitive collegiate athletes, and to speed physical and psychological recovery from surgery. This study assessed the efficacy of a CBSM program to reduce the frequency of injury and illness among competitive, collegiate rowers in a randomized, single-blind, controlled clinical trial. A multi-disciplinary team of researchers from the Division of Psychiatry at Boston University School of Medicine, the Department of Psychology, University of Miami, and the Department of Exercise Physiology, West Virginia University collaborated on this study. Following the assessment of baseline medical history, mood state, stress, cortisol, sleep, alcohol use, and exercise training, collegiate rowers were stratified by gender and competitive level, and randomly assigned to either a control group or a CBSM group. Exercise training information and psychosocial assessments were repeated immediately following the intervention period. Health care providers who were blinded to whether the participant was in the intervention group or the control group recorded the frequency of medical visits and the number of days the athlete was either injured or ill throughout the season. The study found that athletes randomly assigned to a CBSM group experienced significant reductions in the number of illness and injury days, as compared to control group athletes. CBSM participants also had half the number of health service visits as did controls. The data suggest that a time-limited CBSM intervention designed specifically for an athlete population may be an effective prophylactic treatment to reduce the incidence of injury and illness among competitive collegiate athletes.

Citation: Perna FM, Antoni MH, Baum A, Gordon P, Schneiderman N. Cognitive behavioral stress management effects on injury and illness among competitive athletes: a randomized clinical trial. Annals of Behavioral Medicine, 2003 Winter; 25 (1): pp. 66-73.

15 Aug

A review of three pilot studies by J.H. Gruzelier examines the effect of relaxation, self-hypnosis and guided imagery on basic immune functions, and offers a wide range of exciting findings. The author and his colleagues investigated self-hypnosis training that incorporated imagery of the immune system. In two of his studies, hypnosis was found to buffer the effects of stress on immune functions in medical students at exam time. When he compared self-hypnosis with and without immune system imagery, the data confirmed that there were advantages to the targeted imagery. Results in the imagery group showed heightened immune function, improvements in mood, and fewer winter viral infections. A third study looked at patients with virulent and chronic herpes simplex virus-2 HSV-2. Six weeks of training almost halved recurrence, improved mood and reduced levels of clinical depression and anxiety in the intervention group. Immune functions were up-regulated, notably functional natural killer cell activity to HSV-1. The review concludes that these preliminary studies show that hypnosis with targeted imagery provides immune control along with enhanced mood and well-being, and that larger studies with controls are warranted.

Citation: Gruzelier JH. A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health. Stress 2002 Jun;5(2):147-63.

15 Aug

Catherine Sykes and David Marks of Middlesex University in London, in an attempt to see what might reduce smoking among economically disadvantaged, heavy smokers, studied 260 smokers in this randomized, controlled clinical study. 131 subjects were randomly assigned to a cognitive behavioral program (called QFL, or Quit for Life), where they were taught in one hour how to be vigilant around their internal rationalizing to smoke, and to how use guided imagery, relaxation and meditation. After 7-10 days of smoking reduction, they quit and move into a 3-month relapse prevention program over 3 months time. Nicotine replacement therapy is optional (but not free), and was used by an insignificant minority of participants. Subjects are advised that quitting is not a matter of will power but of self-efficacy. 129 subjects were placed in the control condition, a program called SSME (Stopping Smoking Made Easier), which consists of a leaflet or audiotape telling people how to quit, offering facts and figures, and advice around picking a date to stop cold turkey, using will power, getting support from family and friends, arranging for a self-administered reward system after a successful first day, week and month; and to call the "Quitline" if further help is needed. Here too nicotine replacement therapy was optional, and again used only by a small minority of subjects. At the 6-month follow-up, 21 (17.2%) of the 122 participants receiving CBT and relaxation therapy were abstinent and 14 (11.5%) had reduced cigarette consumption by at least 25% of their pre-treatment level. On the other hand, only six (5.6%) of 107 participants in the control group were abstinent and none had reduced consumption. This was in spite of the fact that amount of contact with the program was the same, and use of nicotine replacement therapy was the same. The study concludes that cognitive behavioral and relaxation therapy is more effective than health education advice in helping smokers quit. Smokers need more than information; they need the skills and techniques to enable them to control the psychological processes that underly smoking.

Citation: Sykes, Catherine and Marks, David. Effectiveness of a cognitive behaviour therapy self-help programme for smokers in London, UK. Health Promotion International 2001 Sep;16(3):255-60.

15 Aug

That dynamic Danish research machine from Aarhus University, R. Zachariae, the same fellow who brought you scores of studies about the effects of hypnosis and imagery on reactions to poison ivy, asthma, rheumatoid arthritis and other histamine and autoimmune afflictions, also did a nice study with psoriasis. We get a lot of questions about psoriasis and imagery, so we’re pleased to show you this: Fifty-one patients with psoriasis vulgaris were randomly assigned to a treatment group (where they got 7 individual sessions over 12 weeks, learning stress management, guided imagery and relaxation skills) or a control group. All subjects were measured on the Psoriasis Area Severity Index (PASI), Total Sign Score (TSS) and Laser Doppler Skin Blood Flow (LDBF) at weeks #4, #8 and after treatment was completed. The treatment group showed slight but significant changes in TSS and LDBF. The control group did not. With more in depth analysis, investigators found that the treatment group indeed displayed significant reductions for all three psoriasis activity measures, whereas no changes were found in the controls. The study concludes that behavioral training may produce moderate improvement on this condition.

Citation: Zachariae R, Oster H, Bjerring P, Kragballe K. Effects of psychologic intervention on psoriasis: a preliminary report. Journal of the American Academy of Dermatology, 1996. June;34(6): 1008-1015.

15 Aug

Researchers at the University of Iowa studied how 3 conditions: stress, relaxation and a control condition, can affect an inflammatory response artificially induced by injecting capsaicin, the pungent compound in chili peppers, under the skin. 50 subjects 28 men and 22 women were pre-trained in relaxation, using an imagery-based relaxation tape, and then randomized to one of the experimental groups a 20-minute stress test, a relaxation tape or a video control, followed by a capsaicin injection in the forearm. Digitized measurements of flare were taken for 1 hour after the injection, as well as measurements at regular intervals of cardiovascular variables, cortisol, adrenocorticotrophic hormone, and norepinephrine. Investigators found that the size of the maximum capsaicin-induced flare was significantly smaller in the relaxation group than in the stress or control conditions, which appeared about the same. Increases in norepinephrine, heart rate, and systolic blood pressure during the experimental task, but not after capsaicin, significantly predicted size of maximum flare and total area under the curve of flare measurements. The study concludes that stress reduction may well affect local inflammatory processes. Results are consistent with sympathetic modulation of the effects of relaxation on the flare response.

Citation: Lutgendorf S, Logan H, Kirchner HL, Rothrock N, Svengalis S, Iverson K, Lubaroff D. Effects of relaxation and stress on the capsaicin-induced local inflammatory response. Psychosomatic Medicine 2000 Jul-Aug; 62 (4):pp. 524-34

15 Aug

Contact information for the Transcend program of Drs. Bev Donovan and Edgardo Padin-Rivera, at the Brecksville, OH V.A. hospital.

Drs. Bev Donovan and Edgardo Padin-Rivera, at the Brecksville, OH V.A. hospital, just completed analyzing their research on 48 subjects, showing that their wonderful Transcend program is getting astonishing results with their population of dual diagnosis (substance abuse plus post traumatic stress disorder) Vietnam vets. A full 12 months out of this intensive, multi-modal 12-week program, 85% of their guys aren’t just still clean and sober, but their PTSD symptoms are continuing to improve. This is dramatically different from the usual decline in efficacy a few weeks or months after a typical treatment program.

15 Aug

We have strong indications that our Healing Trauma imagery gives an assist to existing cognitive behavioral and multi-modal programs for PTSD in recovering vets, but Leslie Root, PhD, Ellen Koch, PhD & colleagues at the VA Gulf Coast Veterans Health Care System in Biloxi, Mississippi, wanted to measure the effects of the trauma-specific imagery as the only add-on intervention after each of 5 group treatment sessions for PTSD. This breaks new ground.

15 Aug

A survey of the emergence of stress symptoms in U.S. citizens since the terror attacks of September 11th showed that 44% of adults reported at least one substantial new symptom; 68% reported the emergence of at least one moderate symptom; and 90% a more minor symptom. Reactions varied by sex, race/ethnicity, presence or absence of prior emotional problems, distance from the locus of the attack and by region of the country. Rates of stress were higher with women, nonwhites; in people with previous psychological problems and in people closest to New York City. Stress levels were also associated with extent of television viewing immediately following the attacks. People most typically responded to their upset by turning to religion, turning to one another for support, checking on the safety of others, talking about their thoughts and feelings, participating in vigils and other community rituals, and making donations and doing charitable acts. Some found that to stop watching TV was helpful.

15 Aug

Predictors of secondary trauma in sexual assault trauma counselors.