Therapies to reduce stress and anxiety

Creativity in meeting patients' needs is required daily by the staff in acute and critical care environments. For critical care patients, many alternative and complementary therapies including aromatherapy, hydrotherapy, humor, imagery, massage, music, and relaxation can be used successfully as adjunct therapies to help decrease stress.     

A family intervention to reduce delirium in hospitalised ICU patients: A feasibility randomised controlled trial

BackgroundFamily members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and acceptability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients.MethodA single centre randomised controlled trial in an Australian medical/surgical ICU was conducted. Sixty-one family members were randomised (29 in intervention and 32 in non-intervention group). Following instructions, the intervention comprised the family members providing orientation or memory clues (family photographs, orientation to surroundings) to their relative each day. In addition, family members conducted sensory checks (vision and hearing with glasses and hearing aids); and therapeutic or cognitive stimulation (discussing family life, reminiscing) daily. Eleven ICU nurses were interviewed to gain insight into the feasibility and acceptability of implementing the intervention from their perspective.ResultsRecruitment rate was 28% of eligible patients (recruited n = 90, attrition n = 1). Following instruction by the research nurse the family member delivered the intervention which was assessed to be feasible and acceptable by family members and nurses. Protocol adherence could be improved with alternative data collection methods. Nurses considered the activities acceptable.ConclusionThe study was able to recruit, randomise and retain family member participants. Further strategies are required to assess intervention fidelity and improve data collection.     

Autogenic training to reduce anxiety in nursing students: randomized controlled trial

AIM: This paper reports a study to determine the effectiveness of autogenic training in reducing anxiety in nursing students. BACKGROUND: Nursing is stressful, and nursing students also have the additional pressures and uncertainties shared with all academic students. Autogenic training is a relaxation technique consisting of six mental exercises and is aimed at relieving tension, anger and stress. Meta-analysis has found large effect sizes for autogenic trainings intervention comparisons, medium effect sizes against control groups, and no effects when compared with other psychological therapies. A controlled trial with 50 nursing students found that the number of certified days off sick was reduced by autogenic training compared with no treatment, and a second trial with only 18 students reported greater improvement in Trait Anxiety, but not State Anxiety, compared with untreated controls. METHODS: A randomized controlled trial with three parallel arms was completed in 1998 with 93 nursing students aged 19-49 years. The setting was a university college in the United Kingdom. The treatment group received eight weekly sessions of autogenic training, the attention control group received eight weekly sessions of laughter therapy, and the time control group received no intervention. The outcome measures were the State-Trait Anxiety Inventory, the Maslach Burnout Inventory, blood pressure and pulse rate completed at baseline, 2 months (end of treatment), and 5, 8, and 11 months from randomization. RESULTS: There was a statistically significantly greater reduction of State (P<0.001) and Trait (P<0.001) Anxiety in the autogenic training group than in both other groups immediately after treatment. There were no differences between the groups for the Maslach Burnout Inventory. The autogenic training group also showed statistically significantly greater reduction immediately after treatment in systolic (P<0.01) and diastolic (P<0.05) blood pressure, and pulse rate (P<0.002), than the other two groups. CONCLUSION. Autogenic training has at least a short-term effect in alleviating stress in nursing students.     

Randomized trial of essential oils to reduce perioperative patient anxiety: feasibility study

AIM: This paper is a report of a feasibility study to examine the effectiveness of essential oils in reducing anxiety in thoracic patients awaiting the results of investigative and staging surgery. BACKGROUND: Patient anxiety is expected during the perioperative period. Anxiety places the patient at greater risk of adverse clinical outcomes. Nurses are limited in therapeutic options that can be used to address anxiety in the limited time available. Complementary therapies have been tested for therapeutic benefit but the evidence is weak. METHOD: Patients admitted to a thoracic unit for bronchoscopy/mediastinoscopy in 2005 and 2006 were invited to participate in this double-blind controlled trial and randomized to receive study oil (A), neutral oil (B) or no intervention (C). Intervention was controlled by the patient at home after the procedure. The State Trait Anxiety Inventory and the Hospital Anxiety and Depression Scale were used to measure baseline and periodic anxiety status (days 3, 21). FINDINGS: Of the 142 patients approached to participate, 71 (50%) agreed to take part. There were high and fluctuating levels of perioperative anxiety in the thoracic patient group, but no evidence that this was reduced by the absorption and inhalation of essential oils. CONCLUSION: The study did not provide evidence that the essential oils could reduce anxiety in this group of patients. Both recruitment rates and compliance rates were lower than anticipated. Logistic factors in the setting of diagnostic process for an acute condition may have contributed to these results. More stable settings would be better suited to evaluating such interventions.     

A randomized controlled trial of relaxation training to reduce hot flashes in women with primary breast cancer

Hot flashes are experienced by about 52% of perimenopausal women. After breast cancer, this may increase to 70%. The use of hormone replacement therapy is not recommended in women who have had breast cancer; therefore, alternatives are required to help relieve hot flashes. This study was conducted to assess the efficacy of relaxation training in reducing the incidence of hot flashes in women with primary breast cancer. This was a randomized controlled trial of 150 women with primary breast cancer who experienced hot flashes. The intervention group received a single relaxation training session and was instructed to use practice tapes on a daily basis at home for one month; the control group received no intervention. Outcomes were incidence and severity of flashes using a diary and validated measures of anxiety and quality of life. The incidence and severity of hot flashes, as recorded by diaries, each significantly declined over one month (P<0.001 and P=0.01, respectively), compared with the control group. Distress caused by flashes also significantly declined in the treatment group over one month (P=0.01), compared with the control group. There were no significant differences between the treatment group and the control group at three months and no changes in anxiety or quality-of-life measures. Relaxation may be a useful component of a program of measures to relieve hot flashes in women with primary breast cancer.     

Predictors of and barriers to adherence in a 16-week randomised controlled trial of Bikram yoga in stressed and sedentary adults

BackgroundBikram yoga may enhance health outcomes in healthy adults and those at risk for chronic disease, however, challenges remain in achieving optimal adherence to this practice. This study investigated factors influencing adherence to a 16-week Bikram yoga intervention in stressed and sedentary adults.MethodsExperimental group participants (n = 29) were instructed to attend 3–5 Bikram yoga classes weekly for 16 weeks. Baseline demographics, behaviours and health measures were investigated as predictors of adherence. Barriers were assessed via documentation of adverse events, and exit survey responses.ResultsParticipants (38.2 ± 10.1 years) were predominantly overweight-obese (83%), female (79%), and attended 27 ± 18 classes. Higher adherence was associated with older age (p = 0.094), less pain (p = 0.011), fewer physical limitations (p = 0.011), poorer blood lipid profile, and higher heart rate variability (HRV; total power, (p = 0.097)). In multi-variable analysis, three variables: age (β = 0.492, p = 0.006), HRV (β = 0.413, p = 0.021) and pain (β = 0.329, p = 0.048) remained predictors of adherence. Difficulty committing to the trial, lack of enjoyment and adverse events were barriers to adherence.ConclusionsThese findings should be considered in the development of future Bikram yoga trials to facilitate higher levels of adherence, which may enhance health outcomes and inform community practice. Future trials should investigate and address additional barriers and facilitators of Bikram yoga practice.     

Effectiveness of relaxation for postoperative pain and anxiety: randomized controlled trial

Title.  Effectiveness of relaxation for postoperative pain and anxiety: randomizedcontrolled trial
Aim.  This paper is a report of a study to determine the effectiveness of jaw and total body relaxation for postoperative pain, anxiety and level of relaxation, and to determine any patient expectancy effects.
Background.  Relaxation is increasingly suggested as a pain control technique that can be used by nurses in daily practice. A systematic review of the effectiveness of relaxation for postoperative pain relief revealed many poorly designed studies and only some weak evidence supporting the use of relaxation for postoperative pain.
Method.  A randomized controlled trial ( n  =   118) was conducted between 2002 and 2003 to compare total body relaxation, jaw relaxation, attention control and usual care. Consenting patients admitted for elective orthopaedic surgery aged 18 or over, able to speak English and able to tense and relax more than two muscle groups were included. Pain at rest and on movement, anxiety and relaxation were assessed at pre-admission clinic, pre-intervention, immediately post-intervention and 1, 2, 3 and 4 hours later. However, the trial was under-powered.
Findings.  There were statistically significant reductions in pain at rest from pre- to post-intervention for both the relaxation groups and the attention control group. The usual care group had a small increase in pain, whilst the other three groups had similar small decreases in pain. There was no statistically significant difference in anxiety or relaxation scores pre- to post-intervention between groups.
Conclusion.  Jaw relaxation could give these orthopaedic patients a small, very short-lasting additional amount of pain relief, and it may be that staff and patients feel this small benefit to be worthwhile.     

A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial

BackgroundPatients awaiting cardiac surgery typically experience significant physical and psychological stress. However, although there is evidence that preoperative education interventions can lead to positive postoperative outcomes for surgical patients in general, less is known about the effectiveness among patients undergoing cardiac surgery, especially Chinese cardiac patients.ObjectivesTo determine whether a preoperative education intervention designed for Chinese cardiac patients can reduce anxiety and improve recovery.DesignRandomized controlled trial.SettingsCardiac surgical wards of two public hospitals in Luoyang, China.Methods153 adult patients undergoing cardiac surgery were randomized into the trial, 77 to a usual care control group and 76 to preoperative education group comprising usual care plus an information leaflet and verbal advice. Measurement was conducted before randomization and at seven days following surgery. The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes were change in depression (HADS), change in pain as measured by subscales of the Brief Pain Inventory-short form (BPI-sf), length of Intensive Care Unit stay and postoperative hospital stay.ResultsOf 153 participants randomized, 135 (88.2%) completed the trial. Participants who received preoperative education experienced a greater decrease in anxiety score (mean difference ?3.6 points, 95% confidence interval ?4.62 to ?2.57; P < 0.001) and a greater decrease in depression score (mean difference ?2.1 points, 95% CI ?3.19 to ?0.92; P < 0.001) compared with those who did not. There was no difference between groups in average pain, current pain, and interference in general activity, mood and walking ability. Patients randomized to the preoperative education group reported less interference from pain in sleeping (mean difference ?0.9 points, 95% CI ?1.63 to ?0.16; P = 0.02). There was some evidence to suggest a reduced number of hours spent in the Intensive Care Unit among preoperative education patients (P = 0.05) but no difference in length of postoperative hospital stay (P = 0.17).ConclusionsThis form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac surgery patients. Based upon existing evidence and international practice, preoperative education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery.     

Ocular relaxation to reduce eye movements

Cognitive activities influence the rate and direction of eye movements, but the effect of various levels of eye activity on cognition has not been tested. Jacobson (1938) claimed to have reduced cognitive activity with some eye exercises by decreasing ocular motility. The current study assessed the effects of ocular relaxation eye exercises, adapted from Jacobson, on two subjects with a single-subject withdrawal design. Ocular relaxation brought about a 40% reduction in eye movements but was slightly less efficient at producing physiological and self-reported relaxation than autogenic relaxation. Utility of the procedure in cognition and imagery research and in clinical applications was discussed.