Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy

Cancer patients who had developed negative conditioned responses to their chemotherapy either did (relaxation training) or did not (no relaxation training) receive progressive muscle relaxation training and guided relaxation imagery instructions immediately before and during their chemotherapy treatments. Physiological (blood pressure and pulse rate) measures of arousal, frequency of vomiting, and patient-reported and nurse-reported indices of negative affect and nausea were collected during pretraining, training, and posttraining chemotherapy sessions. Results indicated that during both the training and the posttraining sessions, patients in the relaxation training condition reported feeling less emotionally distressed and nauseated, and showed less physiological arousal following the chemotherapy infusion, than patients in the no relaxation training condition. The attending nurses' observations confirmed the patients' self-reports. No differences were found in frequency of vomiting between conditions. These data clearly suggest that the use of relaxation procedures may be an effective means of reducing several of the adverse side effects of cancer chemotherapy.     

Biofeedback and relaxation in blacks with hypertension: a preliminary study

Previous studies show that stress increases blood pressure as a response to the sympathetic nervous system and that enhancement of parasympathetic activity promotes relaxation and lowers blood pressure. This paper is based on a preliminary study of 22 black subjects with a history of hypertension who were given biofeedback and relaxation training in the Biofeedback Laboratory at Howard University College of Medicine. The guided training consisted of eight weekly sessions using five instruments. Mean blood pressure (BP) was monitored in each session using a Stoelting BP Monitor. Data based on 10 characteristics (age, number of sessions, practice score, social readjustment scale, stress symptoms, systems review, initial and last systolic and diastolic BP) are analyzed and presented in five tables. Although differences between the initial and last readings of the systolic and diastolic BPs and during the test were observed, they were not statistically significant, probably due to small sample size. Analysis was also made by grouping the patients into three groups depending on the increase, decrease, or no change in BP. All patients demonstrated that the biofeedback training was beneficial in lowering the BP. These techniques should be incorporated into daily life to have lasting benefit.     

Blood pressure reactivity can be reduced by a cognitive behavioral stress management program

Although enhanced cardiovascular reactivity is extensively discussed as a relevant negative factor in the alteration of vascular structure, only a few controlled studies have been published presenting approaches to alter reactivity. Therefore, we examined whether enhanced reactivity could be reduced by stress management training (SMT). To control for expectation effects, progressive muscular relaxation (PMR) was the control condition. Forty-four patients with a blood pressure response greater than 15 mm Hg to a mental stress test participated in this study. Participants who took part in SMT showed a significantly stronger reduction of diastolic blood pressure reactivity to a mental stress test from pretest to posttest than the controls. Furthermore, patients who took part in SMT showed significantly smaller systolic blood pressure reactions to mental arithmetic and 2 social stress tests than the controls after the trainings. This study indicates that enhanced blood pressure reactivity can be reduced by SMT.     

Effects of stress management on blood pressure and other cardiovascular variables.

Blood pressure and impedance cardiography derived measures of heart rate, stroke volume, cardiac output and total peripheral resistance were measured in 16 persons before and after participation in a comprehensive program of stress management that included home monitoring of blood pressure and feedback of finger skin temperature during relaxation. Ten of the subjects were hypertensive and six were normotensive. Baseline measures of systolic and diastolic blood pressure and heart rate decreased significantly after participation in the program. In addition, reactivity to a psychological stressor (oral quiz) was significantly lower as revealed in reduced systolic and diastolic pressure, heart rate and cardiac output at the second assessment. A reduction in sympathetic nervous system activity is postulated as a possible mechanism for the changes observed.     

Effects of Brief Relaxation Training on Children;s Motor Functioning

Relaxation training is frequently prescribed in the treatment of anxiety, particularly for children with medical disorders. Unfortunately, very little is known about how different relaxation procedures work with children. To test whether different procedures had different effects, we compared test-anxious children given (a) progressive muscle relaxation training, (b) visual imagery training, or (c) nonspecific instructions to relax on several physiologic, self-report, and performance measures. We found no differences among the groups on the physiological or self-report measures. However, the progressive muscle relaxation and visual imagery groups improved in fine-motor performance following training, whereas the nonspecific instructions group worsened in performance. We discuss issues of arousal intensity and generalization of skills.     

Relaxation pretraining, pulse wave velocity and thermal biofeedback in the treatment of essential hypertension

Twelve white male subjects with a physician's diagnosis of essential hypertension participated in the study over a 3- to 4-month period (23-38 sessions). Subjects were assigned to one of four sequences of training in which the order of presentation of pulse wave velocity (PWV) or thermal feedback, and presence or absence of relaxation pretraining were varied. The overall effectiveness of the treatment program was demonstrated by average blood pressure decreases of 8.8 mm Hg/4.1 mm Hg from initial session measures to follow-up one month after completion of the program. Systolic pressures were significantly lower at follow-up but not diastolic. In addition, 3 subjects had ceased taking any blood pressure medication by follow-up, and maintained normal pressure. The effectiveness of relaxation pretraining was demonstrated by the fact that relaxation pretrained subjects attained significantly greater blood pressure decreases from baseline to the last 3 sessions of training, and by the fact that relaxation pretraining appeared critical in the acquisition of PWV feedback training.     

Effects of education and relaxation training with essential hypertension patients

Thirty subjects with essential hypertension were assigned randomly to either a no treatment control, education, or education with relaxation training group. Independent blood pressure recordings were collected by medical staff at pretest, posttest, and 8-week follow-up. Results suggest a significant interaction between treatment and time for the dependent physiological measure, systolic blood pressure. During the pretest to follow-up period, the control group averaged a 5.9 mm. Hg. increase, the education with relaxation group an 8.8 mm. Hg. decrease, and the education group a 14.9 mm. Hg. decrease in systolic blood pressure. There was no significant difference in group means for diastolic blood pressure within groups over time. As measured at follow-up, education appeared more effective in reducing systolic blood pressure than education with relaxation training. More than one-third of subjects associated unpleasant side effects with their antihypertensive medication. Almost all treatment subjects rated the education and relaxation as helpful for understanding and managing their hypertension.     

Cardiovascular differentiation of emotions.

This study examined the cardiovascular mechanisms governing differential blood pressure changes during the emotions of joy, sadness, fear, and anger. Heart rate, blood pressure, stroke volume, peripheral vascular resistance, cardiac output, and indices of myocardial contractility were measured during fear, anger, joy, sadness, physical action, and neutral imagery conditions in 27 right-handed male volunteers screened for imagery ability, alexithymia, anxiety, and depression. Anger imagery, rather than fear, was accompanied by the largest effects on the cardiovascular system. Increased diastolic blood pressure in anger was associated with maintained levels of peripheral vascular resistance and increased cardiac output and heart rate compared with changes during neutral imagery. Sadness produced a distinct pattern with moderate increases in blood pressure and vascular resistance and a decrease in cardiac output compared with changes during neutral imagery. Fear, action, and joy produced similar blood pressure changes in which systolic pressure increased and diastolic pressure was relatively unchanged. The measurement of cardiac output and determination of vascular resistance changes during emotional imagery demonstrate that previously observed emotion-specific blood pressure responses are produced by underlying patterns of cardiovascular activation, which differ between the major categories of emotions.     

Meditation training and essential hypertension: A methodological study

Meditation training appears to be a promising psychological approach to the control of hypertension. However, most studies to date have had serious deficiencies. This study attempted to correct many of these deficiencies. Forty-one unmedicated hypertensives referred by general practitioners were randomly allocated to three groups. The treatment group (SRELAX) underwent training procedures based on Transcendental Meditation; a placebo control group (NSRELAX) underwent identical training but without a mantra. Both procedures were compared with a no-treatment control group. The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups, compared with the no-treatment controls, with diastolic percentage reductions reaching significance (p<0.05). There was considerable subject variation in response, with overall a mean decline in diastolic blood pressure of 8–10% on 3-month follow-up. Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed.This research was funded by a grant from the Auckland Medical Research Foundation.     

Treatment of hypertension with biofeedback and relaxation techniques.

The present study describes a 16-week trial of the use of a combination of biofeedback and relaxation techniques for the treatment of hypertension. Twenty-two hypertensive patients were randomly allocated to one of three groups: (1) diastolic blood pressure feedback, electromyographic feedback, and verbal relaxation; (2) sham blood pressure feedback; and (3) no treatment. For the 14 patients completing active treatment during an initial or crossover period, the average changes in blood pressure as measured outside the laboratory were minimal (0/-1 and +1/0 mm Hg, supine and standing, respectively). Average blood pressure reduction in the laboratory was no greater with active than with sham blood pressure feedback (-3/-2 vs. -5/-2 mm Hg). One subject, however, after showing no change in blood pressure during sham feedback, achieved pronounced and prolonged improvement following active treatment. Overall results do not support the usefulness of these techniques as primary therapy in most hypertensives.     

Single- and successive-site EMG training in responding to anticipated pain

In a comparison among relaxation procedures, 32 college students were assigned to four groups of equal size. Electromyographic response training was given with biofeedback (EMG training) on the forehead (frontal area) alone, on the frontal area, neck (sternomastoid), and forearm areas in succession, or on these three sites in conjunction with recorded relaxation instructions used at home. Relative to a control group, which received no training, the three biofeedback-trained groups maintained lower EMG levels on the frontal and sternomastoid sites, and the group provided with the relaxation instructions plus EMG training showed lower skin conductance levels. These patterns were generally maintained during the presentation of a stimulus (stressor) that ostensibly signaled an impending electric shock. Other measures, including peripheral temperatures and self-reported anxiety, also showed effects consistent with the stressor presentations but did not differentiate the groups. The results are discussed in terms of common clinical relaxation procedures, an alternative procedure for training several sites simultaneously, and implications for models of EMG training and arousal.This paper summarizes a portion of the data originally presented in a masters thesis by the first author (Diaz, 1982).     

Cognitive distraction and relaxation training for the control of side effects due to cancer chemotherapy

Sixty cancer chemotherapy patients were randomly assigned to one of six conditions formed by a 3(cognitive distraction, relaxation training, no intervention)×2(high anxiety, low anxiety) factorial design. All patients were followed for five consecutive chemotherapy sessions. Outcome measures included patient reports, nurse observations, and physiological indices. Results indicated that distraction patients reported less nausea prior to chemotherapy and lower systolic blood pressures after chemotherapy than controls. Relaxation training patients reported less nausea prior to chemotherapy and exhibited lower systolic and diastolic blood pressures after chemotherapy than control patients. There were no significant differences between distraction and relaxation training patients on any measure. Patients with high initial levels of anxiety exhibited continually elevated levels of distress throughout the chemotherapy experience; however, anxiety level did not interact with the effectiveness of the treatment interventions. Overall, the data support the use of both cognitive distraction and relaxation training for reducing the distress of chemotherapy with both high and low-anxiety patients and suggest that at least some of the effects of relaxation training can be achieved with distraction alone.This study was supported in part by Grant CA 25516 from the National Cancer Institute and Grant PBR-29 from the American Cancer Society.     

Talking Effect and White Coat Phenomenon in Hypertensive Patients

Both white coat effect (the tendency of blood pressure to rise during a medical visit) and talking effect were analyzed in 42 patients with essential hypertension. Blood pressure was measured during the clinic visit and over the subsequent 24-hour ambulatory period, with the physician performing 49 ± 4 measurements for each patient. Three silent periods and two talking periods (stress and relaxation) were randomly allocated in a crossover design and studied, using analysis of variance. During the initial 11-minute silent period, systolic/diastolic blood pressures increased by 6 mm Hg/5 mm Hg. During the subsequent talking periods, these variations were significantly greater: +22 mm Hg/+17 mm Hg. Measures of systolic/diastolic blood pressure were higher during stressful talking than during relaxed talking. The talking and its emotional contents seemed to explain 70% of the white coat phenomenon. To minimize the white coat phenomenon in the clinic, physicians, nurses, and clinicians are advised to measure blood pressure during an initial period of silence.     

The effects of nonconcurrent and concurrent relaxation training on cardiovascular reactivity to a psychological stressor

Eight patients in a cardiac rehabilitation program, after exposure to two psychological stressors approximately equivalent with respect to cardiovascular reactivity, were given nonconcurrent progressive muscle relaxation training and retested for reactivity. They were then provided with relaxation training concurrently with one of the stressors and exposed again to the two stressors. No significant effects for nonconcurrent progressive muscle relaxation training were detected. Concurrent training, in contrast, produced reductions in both systolic and diastolic blood pressure. Reductions resulting from training on the target stressor showed little tendency to generalize to the nontarget stressor; the discrimination was particularly well defined for systolic blood pressure. We conclude that muscle relaxation techniques are maximally effective in reducing reactivity to psychological stressors when relaxation training is provided concurrently with the stressor. Our findings further suggest that to inculcate the relaxation response reliably across different situations, specific training to enhance generalization may be needed.     

Role of relaxation and specific suggestions in hypnotic emotional numbing.

The cognitive characteristics of highly hypnotizable subjects (Highs) allow them to easily modify their cognitive and autonomic state. Under hypnosis, Highs receiving cognitive, fear-like stimulation exhibit the cardiovascular changes typical of fear/stress, but also show an EEG pattern indicating a balance between fear-induced arousal and hypnotic relaxation. Indeed, hypnosis is effective in the attenuation of both emotional experience and behaviour (emotional numbing). The aim of the present experiment was to investigate the possible different role of relaxation and suggestion in hypnotic emotional numbing. Tonic skin conductance, respirogram, heart rate, systolic and diastolic blood pressure were recorded in 3 groups of hypnotized subjects: Group 1 received a fearful guided imagery associated with threat suggestions (Threat) followed by the same fearful suggestion associated with numbing instructions (relaxation and "No-Threat"); Group 2 received the same instructions in the opposite order of presentation; Group 3 received the fearful suggestion with threat instructions twice. The numbing suggestion reduced fear-related emotional experience and autonomic responses; if No-Threat preceded Threat, the heart rate, heart rate variability and blood pressure were also reduced during Threat, in spite of self reports of high negative emotion. Thus, 1) the subjective experience and the autonomic response to fear can be dissociated; 2) the efficacy of numbing suggestion is extended to a subsequent Threat stimulation; 3) habituation does not contribute to the numbing effect. The results indicate that the specific numbing suggestion is the main factor in hypnotic modulation of the experience of fear.     

Relaxation behavior therapy as sole treatment for mild hypertension.

This study tested the efficacy of relaxation therapy as sole treatment for mild hypertension in 110 men and women recruited from a five-stage worksite blood pressure screening program. Participants were randomized to 12-weeks of relaxation therapy or support therapy. Outcome blood pressure assessments made by assessors who were unaware of group allocation revealed similar decreases in both treatment groups at post-treatment and 6-month follow-up. While body weight did not change, alcohol consumption decreased similarly in both groups, and alcohol consumption was positively correlated with both absolute diastolic blood pressure and change in diastolic blood pressure at outcome. In conclusion, a superior blood pressure effect was not associated with relaxation therapy; however, alcohol consumption decreased in both treatment groups, suggesting that both interventions facilitated changes in health risk behaviors and indirectly on blood pressure level.     

Effects of mindful breath awareness and muscle relaxation and transcranial electrical stimulation techniques on improving blood pressure status in patients with type 2 diabetes

ObjectiveThe present study aimed to determine the effects of mindful breath awareness & muscle relaxation (MBMR) and transcranial electrical stimulation (tCES) techniques on improving the systolic and diastolic blood pressure status in patients with type 2 diabetes.MethodsThe research method was randomized controlled trial (RCT) using split-plot ANOVA (SPANOVA). Thirty patients were selected through purposive sampling from Bonab County Diabetes Association (Iran) and were randomly divided into three 10-member groups, namely MBMR, tCES, and MBMR+tCES groups. Participants received their group interventions in 10 individual sessions. All patients were evaluated for systolic and diastolic blood pressure at two stages, before and immediately after each session. SPANOVA and Bonferroni pairwise comparison tests were used for data analysis.ResultsThe results indicated that the MBMR and tCES techniques, alone and in combination, had significant and equal effects on reducing diastolic blood pressure, but the MBMR treatment was more effective in the systolic blood pressure than the tCES.ConclusionsThe MBMR and tCES techniques were effective and safe in treating hypertension in patients with type 2 diabetes.     

Long‐term efficacy of cognitive training for age‐associated memory impairment: A six‐month follow‐up study

The purpose of this investigation was to assess the impact of pretraining on the long‐term effect of an imagery‐based mnemonic in persons with age‐associated memory impairment (AAMI). Eighty‐two participants were randomly assigned to one of six groups: (1) verbal judgment pretraining plus mnemonic training, (2) visual imagery elaboration pretraining plus mnemonic training, (3) relaxation pretraining plus mnemonic training, (4) nonspecific pretraining plus mnemonic training, (5) nonspecific training, and (6) wait list. Participants receiving the three specific pretraining techniques along with mnemonic training (Groups I to 3) recalled more than those receiving nonspecific pretraining with mnemonic training (Group 4) or nonspecific pretraining without mnemonics (Group 5). Participants receiving mnemonic training (Groups 1 to 4) did not differ from nonmnemonic controls (Group 5) at 6 months. The results suggest that specific pretraining strategies can help maintain beneficial effects of imagery‐based mnemonics over time.     

Anger management training with mild essential hypertensive patients

Casual blood pressures and measures of cardiovascular and behavioral reactions to neutral and confrontive interactions were obtained from 13 essential hypertensive patients who received training in anger management and 9 no-treatment control patients. At pre- and posttraining, heart rate (HR) and blood pressure (BP) were measured (a) at rest and (b) during role-play interactions consisting of neutral and confrontation scenes. Behavioral responses were also coded for each interaction. For treatment subjects, a 6-week program in anger management was conducted, which included relaxation training, self-statement modification, and role-play assertiveness training. Treatment subjects exhibited significantly lower casual DBPs at posttraining (M=90.2 mm Hg) than control subjects (M=95.7 mm Hg). Posttreatment casual SBPs for treatment and control subjects were not significantly different. Treatment subjects exhibited significantly more assertive skill and lesser DBP reactivity at posttreatment than their control counterparts during the confrontive interaction but not during the neutral role-play interaction.