The effects of massage therapy alone and in combination with other complementary therapies on immune system measures and quality of life in human immunodeficiency virus.

OBJECTIVES: Determine effects of massage therapy alone and in combination with exercise or stress management-biofeedback treatment on enumerative immune measures, and quality of life in moderately immunocompromised human immunodeficiency virus (HIV) subjects. DESIGN: Randomized prospective controlled trial with 42 subjects randomly assigned to one of three treatment groups or a control group receiving standard care and intervention over a 12-week period. SETTING: Academic medical center. SUBJECTS: Forty-two (42) subjects with HIV infection (40 males; 2 females; aged 27-50 years) met eligibility requirements of CD4+ lymphocyte cell count greater than 200 cells per microliter; no present or recent signs or symptoms of acquired immunodeficiency syndrome (AIDS), and were not hospitalized. INTERVENTIONS: A 45-minute overall body massage once per week; similar massage and supervised aerobic exercise 2 other days per week; similar massage and biofeedback stress management once per week; control receiving standard treatment. OUTCOME MEASURES: Changes in peripheral blood levels of CD4+ lymphocytes, CD8+ lymphocytes, CD4+/CD8+ lymphocyte ratio and natural killer cells; six dimension quality-of-life assessment. RESULTS: No significant changes (p > 0.05) were found in any enumerative immune measure. Significant (p < 0.05) differences for quality-of-life assessment were in health care utilization and health perceptions, favoring massage and stress management compared to massage only and controls. CONCLUSIONS: Massage administered once per week to HIV-infected persons does not enhance immune measures. Massage combined with stress management favorably alters health perceptions and leads to less utilization of health care resources. This suggests that HIV-infected persons receiving massage and stress management would tend to not overutilize health care services, thus possibly reducing health care costs.

Asthma severity, psychophysiological indicators of arousal, and immune function in asthma patients undergoing biofeedback-assisted relaxation.

Asthma is characterized by airway hyper-responsiveness, inflammation, and reversible obstruction. Respiratory tract infection, allergies, air pollution, and psychosocial factors impact the severity and frequency of asthma symptoms. Pharmacotherapy and self-care are the major components in the management of asthma, but behavioral interventions also have the potential to affect asthma morbidity. We conducted a small, randomized controlled study, examining the effects of biofeedback-assisted relaxation in 16 nonsmokers with nonsteroid-dependent mild asthma. Data were collected on asthma symptoms, pulmonary function, indicators of arousal, and cellular immune factors. The trained group evidenced a decrease in forehead muscle tension in comparison to the controls, but no changes in peripheral skin temperature. Decreases in asthma severity and bronchodilator medication usage for the experimental group were observed. Pulmonary function testing revealed a significant difference between groups in FEV1/FVC at posttest, with the E group having a higher ratio than the controls. The cellular immune data showed no significant group differences in total white blood cell or lymphocyte counts, but decreases over time were observed. Significant differences were observed in the numbers of neutrophils and basophils in the trained group compared to controls, which supports the concept of decreased inflammation. Results of delayed-type hypersensitivity skin testing suggested enhanced function, but they were not conclusive. These findings, though limited by size of population, suggest a positive effect of biofeedback-assisted relaxation in young, nonsteroid-dependent asthmatics. The mechanisms underlying linkages between psychological, behavioral, and immune responses in asthma require further study.

Role of mood in outcome of biofeedback assisted relaxation therapy in insulin dependent diabetes mellitus.

Stressful life events and negative mood have been associated with elevated blood glucose and poor self-care in individuals with diabetes. The purpose of this controlled study was to determine the effect of mood state, specifically depression, anxiety, and daily hassles on the outcome of biofeedback assisted relaxation in insulin dependent diabetes mellitus. Eighteen subjects completed the study, nine in biofeedback assisted relaxation and nine in the control group. There were no significant group differences in blood glucose between those receiving biofeedback assisted relaxation and the subjects continuing usual care. Five of the nine experimental subjects and one of the nine control subjects were identified as succeeders according to an arbitrary criterion. Treatment failures were more depressed, more anxious, and took longer to complete the protocol than succeeders. Statistically significant correlations were found between high scores on inventories measuring depression, anxiety, and hassles intensity and higher blood glucose levels and smaller changes in blood glucose as a result of treatment. It is suggested that mood has an important impact on the response to biofeedback assisted relaxation. Further research is necessary to determine whether assessment of anxiety and depression followed by appropriate treatment where necessary should precede biofeedback assisted relaxation in insulin dependent diabetes.

Outcome of biofeedback-assisted relaxation for neurocardiogenic syncope and headache: a clinical replication series.

Preliminary evidence exists through single case reports that psychophysiological interventions may be useful in the treatment of syncope (fainting). To explore this possibility, a case series of ten patients with histories of recurrent unexplained syncope or near syncope, headache, and a poor response to or tolerance for medication was performed. All patients were treated with electromyographic, thermal, biofeedback as well as progressive and autogenic relaxation. Six of the ten patients showed a major decrease in symptoms at the end of treatment. Descriptive comparisons between the improved and unimproved group were made and a detailed case study of one improved patient is presented. The results suggested that biofeedback-assisted relaxation treatment was most effective in younger patients whose syncope was associated with a strong psychophysiological response and whose headaches were intermittent, not daily occurrences.

Good news--bad press: applied psychophysiology in cardiovascular disorders.

Dysregulation in blood pressure control can occur as a result of psychological stress in either the hypertensive or hypotensive direction. Applied psychophysiological techniques incorporating biofeedback and relaxation have been shown to be efficacious in controlled studies of hypertensive patients. Electromyograph, thermal, skin conductance and direct blood pressure feedback have been utilized alone or in combination with relaxation, blood pressure monitoring, and medication. Prediction models are proposed to define what type of hypertensive is most likely to respond with significant blood pressure decrease. Neurocardiogenic syncope is a cardiovascular disorder which manifests itself as lightheadedness, dizziness, syncope, and often migraine-type headache. Preliminary indications suggest that biofeedback-assisted relaxation may also prove beneficial to patients with this syndrome.

Racial and gender effects on the relaxation response: implications for the development of hypertension.

This study was designed to explore the effect of race and gender on the forehead muscle tension and finger temperature response to biofeedback-assisted relaxation training in individuals with normal blood pressure. Forty-five subjects-18 Black and 27 White, 25 males and 20 females-participated in eight sessions of autogenic relaxation training and thermal biofeedback. Multivariate analysis of variance of the variables measured at baseline (systolic BP diastolic BP sodium excretion, anxiety) was significant for gender Univariate analysis showed males different from females in DBP Na(+) excretion, and trait anxiety. Pretest values of muscle tension were similar by gender, but pretest temperatures were lower in males than females. Repeated measures ANOVA for muscle tension showed a significant effect of period. For temperature a significant effect of period, gender and gender x period was observed. Males increased temperature more than females. There was no effect of history of hypertension on the relaxation response. Multiple regression performed on change in muscle tension and change in temperature showed that pretest muscle tension predicted change in muscle tension. Four variables contributed to the variance in change in temperature: pretest temperature, sodium excretion, and state and trait anxiety.

A provisional model to predict blood pressure response to biofeedback-assisted relaxation.

Blood pressure (BP) response to biofeedback-assisted relaxation is not uniform among hypertensive individuals. The purpose of this exploratory study was to determine if selected psychophysiological variables could be used to identify individuals able to lower blood pressure using biofeedback-assisted relaxation. Responders were defined using a preset criterion of 5 mm Hg or greater decrease in mean arterial pressure. A logistic regression model derived from five variables (heart rate, finger temperature, forehead muscle tension, plasma renin response to furosemide, and mean arterial pressure response to furosemide) provided significant predictive power for BP response, exhibiting a sensitivity of 84.6% and a specificity of 80.0%. With future validation, the proposed model may provide useful information to identify patients likely to benefit from biofeedback-assisted relaxation.

Changes in cerebral blood flow velocity associated with biofeedback-assisted relaxation treatment of migraine headaches are specific for the middle cerebral artery.

Twenty-five patients with diagnosed migraine headaches were randomly assigned to a biofeedback-assisted relaxation therapy group or to a group who relaxed on their own. This study confirmed that the biofeedback trained group significantly decreased pain and medication more than the self-relax group. The best responders were those with the more elevated initial cerebral blood flow values and the changes in cerebral blood flow were specific for the middle cerebral artery.

Effect of biofeedback-assisted relaxation on migraine headache and changes in cerebral blood flow velocity in the middle cerebral artery.

Twenty-three patients with diagnosed migraine headaches were randomly assigned to a biofeedback-assisted relaxation therapy group or to a group who relaxed on their own. The biofeedback trained group decreased pain and medication more than the self relax group. Cerebral blood flow velocity was measured in the middle cerebral artery with transcranial doppler (TCD). The trained group significantly reduced systolic and mean cerebral blood flow velocity on the side with the highest velocity.

Effects of group relaxation training and thermal biofeedback on blood pressure and related physiological and psychological variables in essential hypertension.

One hundred and one patients, 70 experimental and 31 controls, with a diagnosis of essential hypertension, were examined for the effects of group relaxation training and thermal biofeedback on blood pressure and on other psychophysiologic measures: heart rate, forehead muscle tension, finger temperature, depression, anxiety, plasma aldosterone, plasma renin activity, and plasma and urinary cortisol. Eighty percent of the participants were medicated. Treatment yielded a short-term success rate, defined as a decrease in mean arterial pressure of 5 mm Hg, of 49% in the experimental group. Other significant short-term changes included a reduction of forehead muscle tension, state anxiety, plasma aldosterone, and increased finger temperature. Follow-up measurements were made approximately 10 months after treatment in 36 patients, 51% of the treatment completers. Twenty of the 36 were short-term treatment failures, while 16 were treatment succeeders. Thirty-seven percent of the short-term succeeders continued to meet blood pressure criterion at follow-up. In short-term succeeders, continued practice of relaxation may influence long-term maintenance of decreased blood pressure. It is suggested that group relaxation training can be beneficial for short-term and long-term adjunctive treatment of essential hypertension in selected individuals.

The effects of biofeedback-assisted relaxation on cell-mediated immunity, cortisol, and white blood cell count in healthy adult subjects.

The effect of biofeedback-assisted relaxation on cell-mediated immunity, cortisol, and white blood cell count was investigated in healthy adults under low-stress conditions. Fourteen subjects were trained with biofeedback-assisted relaxation for 4 weeks, while 17 subjects were controls. The group trained in relaxation techniques showed increased blastogenesis, decreased white blood cell count, due to decreased neutrophils, and no change in cortisol in comparison to the control group. Subjects with lower initial anxiety scores and forehead muscle tension levels showed larger increases in blastogenesis and larger decreases in neutrophils than subjects with higher initial anxiety and muscle tension levels.

Interaction of biofeedback-assisted relaxation and diuretic in treatment of essential hypertension.

Thirty patients with essential hypertension participated in a study designed to compare two treatments: diuretic medication alone (n = 10) and biofeedback assisted relaxation combined with diuretic (n = 20). One of 10 patients lowered BP with diuretic alone and 11 of 20 patients lowered BP with diuretic combined with biofeedback-assisted relaxation. The addition of the behavioral intervention to the diuretic therapy produced a decrease in blood pressure beyond that associated with the diuretic alone. The decrease in BP mediated by diuretic were related to high entry levels of BP, low anxiety, forehead muscle tension, anger expression and plasma renin activity. The BP decrease mediated by combined diuretic and biofeedback-assisted relaxation was associated with high pretreatment BP, anger controlled, low finger temperature and high/normal plasma renin activity.

Racial differences in the relaxation response of hypertensives.

Racial differences in the relaxation response of hypertensives maintained on diuretic were investigated by comparing blood pressure, muscle tension, and hand temperature changes occurring with biofeedback assisted relaxation. Resting blood pressures were not different in blacks compared with whites. Both black and white subjects decreased diastolic blood pressure significantly from baseline values, but only whites significantly decreased systolic blood pressure. Though both blacks and whites significantly decreased forehead muscle tension, black subjects showed no changes in finger temperature while whites increased temperature significantly. The lack of change in finger temperature in blacks may be a reflection of the increased peripheral resistance previously associated with the greater incidence of hypertension in the American black population.

Sustained effects of biofeedback-assisted relaxation therapy in essential hypertension.

The usefulness of biofeedback-assisted relaxation as an adjunct or substitute for pharmacotherapy in essential hypertension can be enhanced if the effects are shown to persist after formal treatment has ended. Patients with essential hypertension successfully treated with biofeedback-assisted relaxation were recalled for follow-up yearly after the termination of treatment. Twenty-six of 40 patients met the BP criterion for success. At one-, two-, and three-year follow-up, 31%, 38%, and 27% of the successful completers continued to meet the criterion for success. The pretreatment-posttreatment decreases in BP were accompanied by decreases in forehead muscle tension and urinary cortisol. Forehead muscle tension, urinary cortisol, and anxiety levels were significantly lower than pretreatment one year after the end of treatment. Self-report data were used to assess continued relaxation practice. No relationship was found between practice and any other dependent measure. It appears that some patients trained in biofeedback-assisted relaxation can maintain lowered blood pressure, muscle tension, anxiety, and cortisol levels over the long term; however, the role of relaxation practice in maintaining these lowered levels remains unclear.

Controlled study of biofeedback-assisted relaxation in type I diabetes.

OBJECTIVE: The effect of biofeedback-assisted relaxation was tested in a randomized trial in 18 adults with insulin-dependent (type I) diabetes. RESEARCH DESIGN AND METHODS: Pretreatment and posttreatment blood glucose values and insulin dosages in the group trained for 10 wk in biofeedback-assisted relaxation were compared with those in the untrained group. RESULTS: Significantly lower average blood glucose levels, percentage of fasting blood glucose levels at target, and percentage of glucose values greater than 11.2 mM were observed in the trained group at posttest compared with the untrained group. CONCLUSIONS: These differences could not be explained by increases in insulin. It is suggested that stress management be considered as an adjunct to the medical management of people with type I diabetes.

Management of a patient with insulin-dependent diabetes mellitus learning biofeedback-assisted relaxation.

Psychological stress can have profound disruptive effects upon glycemic control in individuals with diabetes. Presented here is a case study in which biofeedback-assisted relaxation techniques were used to help a young woman with a 10-year history of insulin-dependent diabetes mellitus to more effectively manage stress, thereby improving glycemic control. Hypoglycemia is a frequently encountered problem with this technique, so the patient was taught to identify causes of hypoglycemic episodes and to take action to prevent their occurrence. The team approach of a diabetes nurse educator working in conjunction with a biofeedback therapist was vital to the success of this program.

Clinical observations on behavioral treatment of a patient with insulin-dependent diabetes mellitus.

This report uses a single case format to describe clinical observations on the use of biofeedback-assisted relaxation in Type I insulin-dependent diabetes mellitus. It is suggested that treatment based on relaxation training may be utilized in diabetics provided that certain conditions are met and that the relaxation procedure is modified to conform to the special requirements of persons taking insulin. Since both client characteristics and type of training protocol can markedly affect outcome, it may be especially important to tailor the training protocol for each insulin-dependent diabetic patient, based on careful and continuous monitoring of treatment effects.

Effect of biofeedback assisted relaxation training on blood glucose levels in a type I insulin dependent diabetic. A case report.

Treatment of unstable Type I insulin dependent diabetes in a female client using relaxation training, biofeedback and stress management is described. Both average and standard deviation of blood glucose values decreased during treatment and improvements were maintained at one year follow-up with constant or slightly decreased insulin dosage. The results are discussed in the light of describing factors which may predispose diabetics to success in relaxation based treatment programs.

Prediction of response to biofeedback-assisted relaxation in hypertensives: development of a Hypertensive Predictor Profile (HYPP).

A group of hypertensive patients who participated in a biofeedback-assisted relaxation program were divided into treatment successes and treatment failures based on the change in their blood pressure. Multiple regression analysis was used to characterize the successes and failures and to develop a hypertensive predictor profile. Hypertensives most likely to lower their blood pressure with biofeedback-assisted relaxation are those in whom there is evidence of autonomic overactivity, for example, cool hands, high heart rates, and evidence of a chronic response to stress, such as high anxiety scores and high normal cortisol levels.

Effect of biofeedback-assisted relaxation on blood pressure and cortisol levels in normotensives and hypertensives.

This report examines the relationship between blood pressure and cortisol in normotensives and hypertensives. Both groups received biofeedback-assisted relaxation training. Both groups significantly decreased their muscle tension levels from baseline. Only the hypertensives decreased their blood pressure and cortisol levels after training. Implications for the role of cortisol in the relaxation response and in hypertension are discussed.