A controlled comparison on the effect of muscle and cognitive relaxation procedures on blood pressure: implications for the behavioural treatment of borderline hypertensives

Cognitive-behavioral therapy for treating hypertension: a systematic review and meta-analysis

The aim of the study is to investigate whether cognitive behavioral therapy (CBT) can help in reducing blood pressure (BP) in patients with hypertension, both systolic blood pressure (SBP) and diastolic blood pressure (DBP), this being the primary outcome. This was a systematic review with a meta-analysis that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The keywords used for the searches were CBT and hypertension and their respective synonyms, and were applied to the Pubmed, EMBASE and Web of Science databases. Eligibility and data extraction were performed by two independent researchers. They assessed the risk of bias using the Cochrane's RoB 2 tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of the evidence. The data was pooled on the basis that all the analyses had a random effects model. Twenty-two studies were included in this review. In the meta-analysis, 11 studies were included in the analyses of the BP outcomes (SBP and DBP), five studies were included in the follow-up evaluation, and two studies in the body mass index (BMI) analysis. The searches included a total of 2897 patients. The studies presented a high risk of bias and very low quality of evidence. We observed an effect of -0.65 (95% CI: -0.91; -0.39) for CBT-based interventions on SBP with high heterogeneity (I2 85%) and a higher effect of -0.78% (95% CI: -1.13; -0.43) on DBP with even greater heterogeneity (I2 92%). We observed that CBT did have an effect on reducing BP and BMI in hypertensive adults. However, due to the considerable heterogeneity between the studies, the high risk of bias, and the low overall quality of evidence, confidence in these findings should be limited.

Influence of Initial Severity of Depression on the Effectiveness of a Multimodal Therapy on Depressive Score, Heart Rate Variability, and Hemodynamic Parameters

Depression is a major cause of disability among populations worldwide. Apart from primary symptoms, depressed patients often have a higher cardiovascular risk profile. Multimodal therapy concepts, including exercise, have emerged as promising approaches that not only improve depressive symptoms but also have a positive impact on cardiovascular risk profile. However, controversies have arisen concerning the influence of baseline severity on the effects of therapy concepts for this demographic. This study assessed whether pretreatment severity moderates psychological and physiological treatment outcomes of a multimodal therapy. A total of 16 patients diagnosed with mild depression (MD) and 14 patients diagnosed with severe depression (SD) took part in a 3-month outpatient multimodal treatment therapy. Before and after the treatment, depression score (Beck Depression Inventory (BDI)), peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), heart rate (HR), and parasympathetic parameters of heart rate variability (RMSSD) were assessed. Significant time effects were detected for BDI (−20.0 ± 11.6, p > 0.001, η2 = 0.871), pSBP (−4.7 ± 6.8 mmHg, p < 0.001, η2 = 0.322), pDBP (−3.5 ± 6.9 mmHg, p = 0.01, η2 = 0.209), cSBP (−4.8 ± 6.5 mmHg, p < 0.001, η2 = 0.355), cDBP (−3.6 ± 6.8 mmHg, p = 0.008, η2 = 0.226), PWV (−0.13 ± 0.23 m/s, p = 0.008, η2 = 0.229), HR (4.3 ± 8.8 min−1, p = 0.015, η2 = 0.193), RMSSD (−12.2 ± 23.9 ms, p = 0.017, η2 = 0.251), and and SDNN (10.5 ± 17.8 ms, p = 0.005, η2 = 0.330). Significant time × group interaction could be revealed for BDI (p < 0.001, η2 = 0.543), with patients suffering from SD showing stronger reductions. Pretreatment severity of depression has an impact on the effectiveness of a multimodal therapy regarding psychological but not physiological outcomes.

The effectiveness of Jacobson's progressive muscle relaxation technique on maternal, fetal and neonatal outcomes in women with non-severe preeclampsia: a randomized clinical trial

Background

Preeclampsia (PE), as the most common major pregnancy disorder, has serious maternal, fetal and neonatal complications, and outcomes. The present study was designed to determine the effectiveness of Jacobson's progressive muscle relaxation technique on maternal, fetal, and neonatal outcomes in women with non-severe preeclampsia (PE).

Methods

This is a randomized clinical trial conducted from March 21, 2021 to July 22, 2021 in the Kamali referral center in Karaj, Iran. A total of 88 eligible participants were assigned to intervention and control groups (44 in each group) via blocked randomization. The intervention group (6 groups of 6 participants and one group of 8 participants) received Jacobson's progressive muscle relaxation technique in addition to receiving routine care, twice a week for 6 weeks (4 face-to-face sessions and 8 online sessions). The control group only received routine perinatal care. A checklist collected data before and after the intervention. Data were analyzed in SPSS software v.23. To analyze the obtained data, independent t-test, Paired t-test, Mann-Whitney, Chi-square, and Fisher test were used.

Results

The results showed a statistically significant difference between intervention and control groups in terms of Systolic Blood pressure (SBP) (P < 0.001), Diastolic Blood pressure (DBP) (P < 0.001), 24-hour urine protein level (proteinuria) (P < 0.001). and Fasting Blood Sugar (FBS) (P < 0.001), birth Weight (BW) (P = 0.01), baseline Fetal heart rate (BFHR) (P < 0.001) and Number fetal movements based on non-stress test (NFMsN), during 20 min (P < 0.001) after intervention (P < 0.001).

Also In the intervention group, the results showed a statistically significant difference in Amniotic Fluid Index (AFI) (P = 0.01), SBP(P < 0.001), DBP(P < 0.001), proteinuria (P < 0.001), FBS(P < 0.001), BFHR based on non-stress test (NST) (P < 0.001), and NFMsN during 20 min (P < 0.001) in the intervention group before and after the intervention. There was no statistically significant difference in the control group.

Conclusion

This study's results showed the effectiveness of progressive muscle relaxation technique on the improvement of SBP, DBP, proteinuria, FBS, FHR and NFMsN during 20 min based on NST and BW in women with non-severe PE. Therefore, it is recommended to perform this technique in health centers.

Effects of psychotherapy in combination with pharmacotherapy, when compared to pharmacotherapy only on blood pressure, depression, and anxiety in female patients with hypertension

We investigated effects of metacognitive detached mindfulness therapy and stress management training on hypertension and symptoms of depression and anxiety, as compared to a control condition. A total of 45 female patients (mean age: M = 36.49 years) were randomly assigned to one of three conditions: metacognitive detached mindfulness therapy, stress management training, and the control condition. Blood pressure and symptoms of depression and anxiety decreased from baseline to post-test, to follow-up. Group comparisons showed that blood pressure and symptoms of depression and anxiety decreased more in psychotherapeutic groups than in the control group. Psychotherapeutic treatment of hypertension reduced blood pressure and symptoms of depression and anxiety. Positive effects were observable at follow-up 8 weeks later.

Relaxation training methods for nurse managers in Hong Kong: a controlled study

Nurse managers are under increased stress because of excessive workloads and hospitals' restructuring which is affecting their work tasks. High levels of stress could affect their mental health. Yet, few stress management training programmes are provided for this population. The purpose of this study was to apply stretch-release relaxation and cognitive relaxation training to enhance the mental health for nurse managers. A total of 65 nurse managers in Hong Kong were randomly assigned to stretch-release relaxation (n = 17), cognitive relaxation (n = 18), and a test control group (n = 35). Mental health status was assessed using the Chinese version of State-Trait Anxiety Inventory and the Chinese version of the General Health Questionnaire. Participants were assessed at the pretreatment session, the fourth posttreatment session, and at the 1-month follow-up session. The results revealed both the stretch-release and cognitive relaxation training enhanced mental health in nurse managers in Hong Kong. The application of relaxation training in enhancing mental health status for nurses and health professionals is discussed.

Group cohesion and working alliance: prediction of treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy

BACKGROUND

Various definitions of both group cohesion and working alliance are used in theories on group psychotherapy, making the study of their relative contribution to the treatment outcome difficult. In this study, two different, nonoverlapping questionnaires were used to explore the relationship between group cohesion, working alliance and treatment outcome in a time-limited, structured cognitive behavioral group psychotherapy aiming at the reduction of coronary risk factors.

METHODS

After having undergone percutaneous transluminal coronary angioplasty, 42 patients were treated with the aim to reduce exhaustion, anxiety, hostility and depression. The newly developed Group Cohesion Questionnaire (GCQ) and the Helping Alliance Questionnaire (HAQ-II, measuring the bond between individual patients and the group psychotherapist) were administered after the fifth and tenth treatment session. Exhaustion, quality of life, anxiety, blood pressure and heart rate were measured before and after treatment. To test the relationship between the GCQ, the HAQ-II and outcome variables, Pearson Product-Moment correlations and hierarchical regression was applied.

RESULTS

Principal Component Analysis of the GCQ yielded two dimensions, the bond with the group as a whole and the bond with other group members. Hierarchical regression showed that both the bond with other group members and working alliance contributed significantly and independently to the prediction of posttreatment systolic and diastolic blood pressure as well as posttreatment quality of life (confidence).

CONCLUSIONS

Conceptually and empirically, group cohesion and the working alliance may be considered to represent different relationships in a psychotherapy group, contributing in different ways to the treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy.

Can relaxation lower metaboreflex-mediated blood pressure elevations?

PURPOSE

Relaxation can lower resting blood pressure, and this investigation sought to determine whether relaxation could reduce mean blood pressure (MBP) elevations produced by postexercise circulatory occlusion (PECO).

METHODS

Sixteen volunteers trained with relaxation and were able to decrease MBP at rest by at least 5 mm Hg within 2 min. Subjects performed four tests assigned randomly: i). rest with cuff occlusion, ii). rest and cuff occlusion with relaxation, iii). hand-grip exercise followed by PECO rest with cuff occlusion, and iv) hand-grip exercise followed by PECO with relaxation. Data for HR and MBP were collected using a Finapres; ratings of relaxation and discomfort from cuff occlusion were obtained using a 1- to 10-unit scale. Stroke volume (SV) and HR were collected from six subjects to calculate cardiac output and total peripheral conductance (TPC). Dependent variables were compared using an ANOVA.

RESULTS

HR (mean +/-SD) was lower during both relaxation conditions as compared with control (-7 +/- 4 bpm vs -2 +/- 3 bpm; P< 0.05). The MBP was reduced during relaxation alone (-6 +/- 3.7 mm Hg; < 0.05) but not during PECO with relaxation. The rating of relaxation was higher during relaxation (6.8 +/- 1.3 units) versus control (3.5 +/- 1.2 units), but ratings were not different between relaxation conditions. Ratings of discomfort were higher during PECO ( P< 0.05). Relaxation did not significantly alter CO or SV (N= 6). During relaxation alone, TPC was increased (0.046 +/- 0.001 vs 0.049 +/- 0.002 L.min.mm Hg; P< 0.05). However, TPC was significantly increased during PECO with relaxation.

CONCLUSIONS

These findings suggest that although relaxation can affect cardiovascular regulation and lower HR and MBP at rest, this central signal cannot lower reflex increases in blood pressure originating from a peripheral metabolic stimulus.

Effects of progressive muscle relaxation on blood pressure and psychosocial status for clients with essential hypertension in Taiwan

This study examined the effect of progressive muscle relaxation (PMR) on blood pressure and psychosocial status in clients with essential hypertension. The study, which used a quasi-experimental design, recruited a convenience sample of 40 subjects from a hypertension outpatient clinic. Twenty subjects received PMR training once a week and practiced at home daily for 4 weeks. PMR training had an immediate effect, reducing pulse rate 2.35 beats/min, systolic blood pressure 5.44 mm Hg, and diastolic blood pressure 3.48 mm Hg. After 4 weeks of PMR training, further decreases in pulse rate (2.9 beats/min), systolic blood pressure (5.1 mm Hg), and diastolic blood pressure (3.1 mm Hg) occurred. PMR significantly lowered patients' perception of stress, and it enhanced their perception of health. PMR is beneficial for patients with essential hypertension, and nurses may use it to enhance their independent function as well as their quality of life.

Biobehavioral approaches to the treatment of essential hypertension

Despite recent advances in the medical management of hypertension, chronically elevated blood pressure remains a major health problem in the United States, affecting almost 50 million Americans. It is widely recognized that lifestyle factors contribute to the development and maintenance of elevated blood pressure. This article critically reviews current approaches to the nonpharmacological treatment of high blood pressure and highlights outcome studies of exercise, weight loss and dietary modification, and stress management and relaxation therapies. Methodological issues in the assessment and treatment of hypertension are discussed, along with possible mechanisms by which lifestyle modification may reduce elevated blood pressure.