Biomedical subjects
Publications and source records attributed to K R Gaarder.
The emotional significance of diagnosis to patients must not be overlooked in medical therapeutics. Many cases require successful interaction with the patient about what is wrong before treatment can succeed. Treatment failure is often based upon a misunderstanding between patient and doctor about the nature of the problem to be treated.
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This article is the third in a series of studies designed to evaluate systolic blood pressure biofeedback and relaxation in the treatment of elevated blood pressure. It reports on the posttreatment follow-up results. The main findings were that patients who received the behavioral treatments could achieve and sustain reductions in blood pressure for at least 18 months. Furthermore, a number of patients who were receiving diuretic therapy to control their pressures were able to maintain reduced pressure for at least 9 months after discontinuing medication. A model for a behavioral-stepped care program is proposed.
The effects on blood pressure of regular patient and professional monitoring of blood pressure, extensive patient-involved assessment of results, relaxation, and systolic blood pressure biofeedback are analyzed by comparisons of data from two 3-month treatment periods with results from a 1-month baseline period and by comparisons among control and treatment groups. Ninety borderline hypertensive patients completed the treatments. Major findings are: A Acute effects; 1) Both relaxation and systolic blood pressure biofeedback lowered blood pressure acutely. 2) Improvement in performance of relaxation and biofeedback with practice showed that they are learned skills. 3) Acutely, relaxation and biofeedback were equally effective for lowering systolic blood pressure, but relaxation lowered diastolic blood pressure more. B. Long-term effects; 1) Blood pressure declined for at least 6 months with regular monitoring and patient-involved assessment. 2) The greatest lowering of blood pressure by behavioral intervention occurred during periods when pressures tended to be highest. 3) A combination of relaxation and biofeedback, with biofeedback preceding relaxation, was better than either used alone and slightly, but not significantly, better than relaxation preceding biofeedback. 4) The long-term effects of biofeedback were slightly greater than those of relaxation. A staged, incremental behavioral treatment of borderline hypertension is proposed.
A group of 125 patients was enrolled in a study designed to evaluate the effectiveness of two behavioral treatments of high blood pressure, "relaxation' and systolic blood pressure "biofeedback." All patients monitored their pressures three times daily and also had their pressures recorded by a health professional weekly for a one-month, baseline period. This article reports only the results form the baseline period. The main findings are: 1) extensive self-monitoring of blood pressure is feasible and practical; 2) systolic pressure rises throughout the day, but is highest in the afternoon; 3) diastolic pressure falls form morning to evening, but is highest in the afternoon; 4) intradaily range of systolic but not diastolic blood pressure is higher among women than among men; 5) both systolic and diastolic pressures fall throughout the first 3 weeks; 6) standard deviations and ranges of self-determined blood pressures are highly intercorrelated; however, changes in professionally measured blood pressures are poorly correlated with these indices of blood pressure lability; 7) systolic pressure levels, rates of decline throughout the baseline period and lability indices are correlated with age, but comparable measures of diastolic blood pressure are not correlated with age.
Two methods of relaxation therapy, electromyograph biofeedback and autogenic training, were compared to a nonrelaxation treatment, electrosleep therapy, in reducing sleep latency among 22 chronic, sleep-onset insomniacs. While none of the electrosleep patients improved on all-night laboratory electroencephalographic sleep records or daily home sleep logs, approximately one-half of the relaxation-treated patients showed marked improvement, which was sustained over a 1-month follow-up period. Although some sleep and treatment variables differentiated relaxation therapy responders from nonresponders, external stress appeared to be the most salient factor. Successful and unsuccessful patients could not be differentiated on any of the psychological variables studied.
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.