This dissertation investigated the effect of a Doctor Interactive Group Medical Appointment (DIGMA), a unique multidisciplinary medical treatment modality, upon the health behavior of hypertensive patients at the Veterans Health Administration Outpatient Clinic (VA-OPC) in Austin, Texas. Health behavior modification, differences in stress perceptions, blood pressure changes due to the intervention and differences in coping strategies were assessed. Integrated healthcare utilizes a multidisciplinary approach in considering physiological and psychological aspects of health, promoting patients to act on their own behalf in managing health. Increased healthcare costs, decreased patient satisfaction of care received and practitioner satisfaction in care provided currently afflict primary healthcare. Earlier, a “drop-in” shared medical appointment aimed to improve continuity of care, and increase patient and physician satisfaction by allowing patients better access to physicians without taxing more resources. Contrasting the “drop-in” model, this study examined the efficacy of a multi-session DIGMA. Functioning as an adjunct to hypertensive management, participants attended 5 sessions, including one introduction meeting, three consecutive weekly group sessions and an individual telephone session occurring one week following the intervention. The study utilized a pretest/posttest design, with participants acting as their own controls. Self-report measures and blood pressure readings were administered prior to the onset, and again at termination of the DIGMA program. Analyses of variance and hierarchical regression models helped reveal any significant changes in health behaviors, perceptions of stress, and coping styles related to hypertension among 58 participants occurring over time for 7 distinct cohorts participating in the DIGMA. Findings revealed significant differences in both systolic and diastolic blood pressure readings between pre and post intervention. Significant changes in health promoting behaviors among participants who successfully completed all components of the program were also detected. In addition, adaptive coping strategies were found to significantly impact components of health behaviors. Qualitative information supports the quantitative data in determining whether the agent of change is the group process itself, the information imparted in the group, or some other variable. Findings reveal the dynamic of the group, as well as the modality in which information was conveyed positively influenced health behavior changes. Results, implications, and limitations of the study as well as future directions are discussed. / text

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A growing literature suggests that training in relaxation or meditation results in significant reductions in blood pressure in hypertensive patients. The present study was designed to assess the efficacy of a combination relaxation and meditation training program structured by the author and previously used in treatment of a broad spectrum of anxiety-related clinical problems of either a medical (somatic) or a psychological (cognitive and emotional) nature. The 20 subjects were a heterogeneous clinical group of veterans with mild hypertension who were seen at the Tucson Veterans Administration Medical Center. Volunteers were randomly assigned to either (I) an education/cognition group, (II) a three-treatment relaxation/meditation group, or (III) a six-treatment relaxation/meditation group. Blood pressure, anxiety, and stress were measured at regular intervals during training and follow up. All groups were trained over a six-week period. Both relaxation/meditation groups were taught the same skills; only the schedules for training were varied. The educational group, conceived as a control for therapist attention, was, in fact, a cognitive treatment group. Statistically significant reductions in both systolic and diastolic blood pressure were found over time in all groups, while no difference in blood pressure reductions was found among the groups. Anxiety scores increased over time, and no correlation was found between subjective anxiety and objective blood pressure measures. Means of both systolic and diastolic blood pressure were lower at times when subjects reported no stress. Results of this study tend to support those of previous studies, finding statistically significant reductions in systolic and diastolic blood pressure over time in two groups of hypertensive subjects trained in relaxation and meditation techniques. No difference was found, moreover, between these groups and an education/cognition group, suggesting that group techniques, in either significant lowering of blood pressure. This finding lends support to a multiprocess theory which suggests that all treatments have multiple effects.

No description available.

Current clinical diagnostic procedures may lead to an V over-identification of hypertension. The lack of a comprehensive assessment may also lead to difficulty in timing cognitive-behavioral interventions to coincide with periods when blood pressure is most elevated. The goals of the current study were (a) to determine if a laboratory relaxation procedure would be capable of discriminating those individuals who generally have elevated blood pressure from those who react with increased blood pressure specifically to laboratory assessment, and (b) to identify "markers" of emotional states which would enable individuals to determine when their blood pressure was elevated. Fifty-one undergraduate students at Virginia Tech volunteered to participate in a two-hour laboratory session consisting of baseline blood pressure measurements, a relaxation procedure and a battery of psychological questionnaires assessing anger, anxiety and Type A. This was followed by a two-day self-monitoring period consisting of approximately twelve self-reports of mood state concurrent with blood pressure measured by a portable, semi-automatic monitor. Results suggested that blood pressure response to the laboratory relaxation procedure was associated with the difference between average ambulatory blood pressure and laboratory blood pressure for diastolic A blood pressure only. Anger arousal and anger expression were unrelated to either average ambulatory blood pressure or high versus low ambulatory blood pressure readings. Perceptions of the environment as hostile and demanding did discriminate between high versus low systolic blood pressure and diastolic blood pressure readings. A cluster of negative moods discriminated between high and low systolic blood pressure readings. A cluster of moods characteristic of the Type A behavior pattern also discriminated high versus low systolic blood pressure readings as well as high versus low heart rate readings. One of the clearest findings of the study was the relationship between the type of analysis used and the probability of finding an association between psychological variables and blood pressure. In general, across subject analysis yielded fewer significant relationships than analyses emphasizing within subject variation. Exploring this further, two case studies are presented which illustrate statistical procedures for analyzing the relationship between blood pressure and mood in single case designs. / Ph. D.

Bibliography: leaves 67-75

The validity of the Self-Consciousness Scale (SCS) for use with adolescents was investigated. Also, a path model of blood pressure based on the cognitive social learning theory was tested using sets of biological (i.e., family history of hypertension and age), psychological (i.e., public self-consciousness, private self-consciousness, suppressed anger and outwardly expressed anger), and lifestyle (i.e., relative weight and smoking) variables.Subjects were 169 female and 124 male adolescents from the southeastern United States. Parents provided information about the subjects' family history of hypertension and health. Subjects completed the SCS and Anger Expression Scale and a health questionnaire. Subjects' blood pressures, weights, and heights were assessed. Data from all subjects were used for the SCS analyses. Data from 36 subjects who reportedly had health problems or used drugs with cardiovascular effects were excluded from the path model analyses.The SCS data were factor analyzed. Based on the initial analysis, four items were excluded from the data. The subsequent factor analysis suggested that the SCS is a valid measure of the dimensions of self-consciousness in adolescents. Test-retest reliabilities and internal consistencies of the SCS showed reasonable reliability. Comparisons of the SCS scores between college students and adolescents and between female and male adolescents were made.The path model was tested separately for males and females on both systolic blood pressure (SBP) and diastolic blood pressure (DBP), using hierarchical multiple regression analyses of sets. Although the variables collectively explained a significant amount of variance in DBP and SBP for both sexes, few had significant direct and total effects on DBP and SBP, and none had indirect effects on DBP or SBP. Sex differences emerged in the variables' effects on DBP and SBP and the variables' effects on other variables. DBP and SBP increased as relative weight increased for both sexes. No other variables influenced SBP or DBP for males or SBP for females. Females with a positive family history of hypertension had higher DBPs. Females' DBPs decreased as private self-consciousness increased. The implications of the findings and suggestions for future research are discussed. / Department of Counseling Psychology and Guidance Services

Essential hypertension has a complex and multiple biological, psychological and social aetiology and remains one of the most serious physical disorders affecting the Black population of South Africa today. Pharmacological treatment has been the predominant approach to blood pressure reduction, but considering that the greater part of essential hypertension has its origin in biobehavioural and cognitive functioning a non-pharmacological treatment approach to essential hypertension is receiving extensive interest both in research and therapeutic practice. This study attempted to implement a specific cognitive-behavioural treatment "package' which was tailored to the emergent aetiology in an urban Xhosa woman suffering from Mild hypertension who was on antihypertensive medication and to evaluate the treatment using a single case-study methodology. A combination of relaxation training and cognitive-behavioural modification was provided over a fifteen week period and evaluated both quantitatively and qualitatively. It was found that a combination of over-weight, occupational stress and anger could have contributed and/or caused the patient's hypertension. The results also show a significant reduction in blood pressure during the treatment phase as well as a reduction in weight, experienced anxiety and angry emotion, and by the end of the study the patient's blood pressure had been reduced to normal levels. Finally the feasibility of using such a treatment approach is discussed in relation to the South African context and the case study method is evaluated as a research tool in light of the findings.

M.A. (Clinical Psychology) / Hypertension is a current health science priority. This is because it is associated with chronic diseases such as coronary disease. Further it is known to cause end organ damage. It has been clearly established over the last 20 years that antihypertensive drug therapy decreases mortality in those with moderate or severe hypertension. However, the use of drugs for long-term prophylaxis carries with it the risk of long-term side effects. It is for this reason that the need for non-pharmacological treatment of hypertension has risen. The wider acceptance of a more cautious. conservative approach towards drug therapy in general seems necessary. Biobehavioral approaches to the treatment of hypertension have been a 'promising' aItemative or adjunct to drug treatment programmes. However. these approaches have been met with limited success due to the fact that they fail to take into account the effect of family systemic variables as a contributing factor in the causation and maintenance of hypertension. This study investigated the possibility that biopsychosocial techniques offer an added dimension to the biobehavioral approach to the treatment of hypertension by taking into account the familial systemic variables which may contribute to maintaining hypertension. The biopsychosocial techniques may playa significant adjunctive role in permitting control of blood pressure to be maintained without the side-effects seen with the chronic use of medication. An exploratory study was conducted in which a single-subject. AS design was utilized in order to determine whether the added component of a systemically based family intervention would add to decrease or increase the effects obtained with the Fahrion Mayo-protocol. In this context five subjects were consecutively Subjected to health information. muscle relaxation training and biofeedback-assisted training. The systems-based family intervention occurred-throughout the procedure. There was significant decrease across all five subjects of baseline to follow-up systolic blood pressure. This could indicate that the programme as a whole provided an effective decrease in systolic blood pressure. Of particular interest is the possibility that the biofeedback-assisted training intervention could be a placebo intervention associated with the technological nature of the intervention. It is therefore quite clear that the data would be indicative of a non-biofeedback, but relaxation. health information and systemic family intervention to be effective in the treatment of hypertension.

Self-monitoring, lowered arousal training (i.e., biofeedback and relaxation training) and maintenance follow-up appeared to contribute to effective treatment of hypertension. Cognitive therapy, while effective in treatment of some stress-related disorders, has not been studied as a specific treatment component for hypertension. The present study explored the use of cognitive therapy as a treatment variable to reduce blood pressure in hypertensive persons. The effectiveness of a multi-element treatment including cognitive therapy, blood-pressure biofeedback, and relaxation training was also assessed. Self-monitoring and maintenance training were included as a part of each treatment process.