The relationship of expectancies to outcome in stress management treatment of essential hypertension: results from the Joint USSR-USA Behavioral Hypertension Project.

Outcome expectancy and efficacy expectancy measures were made during the course of a cross-cultural comparison of thermal biofeedback and autogenic training as treatments for mild essential hypertension. There were no differences between groups at either pre- or posttreatment, and expectancy measures were not related to initial success or failure at the completion of treatment. However, both outcome and efficacy expectations were related to relapse over the three months immediately following the completion of treatment. Treatment failures had lower ratings for both outcome and efficacy expectations at the posttreatment assessment in comparison to treatment successes. Implications of these results are discussed.

A preliminary investigation of prediction of mean arterial pressure after self-regulatory treatments.

This study investigated the ability of pretreatment variables from three different domains (social-demographic, psychological, and psychophysiological) to predict posttreatment mean arterial pressure (MAP) for 59 unmedicated males with mild hypertension who were participating in a cross-cultural (USA-USSR) comparison of autogenic training and thermal biofeedback to a self-relaxation control. The overall multiple regression equation consisted of two variables and indicated that higher diastolic blood pressures during a cold pressor task were predictive of greater MAP reductions while higher scores on the Irritability subscale of the Buss-Durkee Hostility Scale were predictive of less MAP reductions. Suggestions for future research in this area are provided.

[A method of rapid psychological diagnosis of patients with a history of myocardial infarction]. / Metodika psikhologicheskoi ekspress-diagnostiki u bol'nykh, perenesshikh infarkt miokarda.

The aim of the study was to develop a compact questionnaire for analysis of the psychological status of patients who had survived a myocardial infarction (MI) meant for physicians with no special psychology or psychiatry training. For this purpose of 185 questions selected by expert method on the data of 236 cases of MI using the program of stepped discriminant analysis, 37 most informative questions were chosen. These questions allowed determination of the general response to MI (adequate or neurotic) as well as of the degree of overestimation or negation of the disease and the degree of anxious-depressive syndrome. On the basis of the obtained data a method of psychologic express diagnosis (PED) for assessment of the named variables was developed. PED is aimed at wide practical use for psychological screening of patients who had survived a MI.

[Psychophysiological correlations and reactivity of patients with hypertension]. / Psikhofiziologicheskie sootnosheniia i osobennosti reaktivnosti u bol'nykh gipertonicheskoi bolezn'iu.

A clinical psychophysiologic and psychologic assessment was made twice, at 12 months' interval, in 203 patients with essential hypertension (EH). In addition to aggravated heredity, EH patients showing more marked BP increment under emotional stress had higher level of anxiety, rigidity and interpersonal conflicts. Different cardiovascular response to various emotive stressors was dependent on psychological characteristics of EH patients. EH patients with increased BP over follow-up period originally showed more marked diastolic BP response to emotional stress, and slower BP recovery after the exposure.

The effects of thermal biofeedback and autogenic training of cardiovascular reactivity: the joint USSR-USA Behavioral Hypertension Treatment Project.

Cardiovascular reactivity (heart rate, systolic, and diastolic BP) to mental arithmetic and cold pressor were measured before and after treatment as part of the cross-cultural (USSR and USA) evaluation of thermal biofeedback and autogenic training (in comparison with self-relaxation) as treatments for mild hypertension in unmedicated males. There were no statistically reliable decreases in cardiovascular reactivity from before to after treatment. However, downward shifts in basal levels of systolic and diastolic BP at post-treatment led treated patients to have lower stress-induced levels of BP.

Psychophysiological interrelations and reactivity characteristics in hypertensives.

Two hundred three patients with essential hypertension (20- to 55-year-old men) were examined initially and at the end of a 1-year follow-up. Clinical, psychological, and psychophysiological methods were used. In the psychophysiological assessment, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, and respiratory rate were recorded at rest and during various emotional stressors. Patients who exhibited a greater increase in blood pressure during psychological stress, in addition to an inherited predisposition to essential hypertension, had higher levels of assertiveness and interpersonal conflict. The differences in cardiovascular response to various emotional stressors depended on the psychological features of the hypertensive patients. An SBP increase during the performance of mental arithmetic correlated with anxiety level, whereas a DBP increase was associated with assertiveness. Changes in SBP and DBP during a stressful computer game correlated with the level of competitiveness and conflict. Hypertensive patients who exhibited an increase in blood pressure during the follow-up were characterized initially by a greater DBP increase during emotional stress and a longer recovery period.

The USA-USSR collaborative cross-cultural comparison of autogenic training and thermal biofeedback in the treatment of mild hypertension.

We have conducted a cross-cultural (USA and USSR) comparison of thermal biofeedback (TBF) and autogenic training (AT) to a self-relaxation control condition in 59 unmedicated males with mild hypertension. Identical assessment and treatment protocols were carried out in both settings (Albany, New York, and Moscow). Treatments were delivered in small groups on an outpatient basis twice per week for 10 weeks. Results showed comparable, significant (p less than .05), short-term decreases (M = 8.5 mm Hg) in diastolic blood pressure (DBP) for both treatments at both sites. However, the Soviet patients, starting with significantly (p less than .01) higher systolic blood pressures (SBPs), showed significant decreases (M = 12.8 mm Hg) in SBP, whereas the American patients did not change appreciably (M = 4.6 mm Hg). During follow-up, the treated Soviet patients showed significantly (p less than .05) better maintenance of treatment effects, from 3 months to 1 year, than did the American patients. At 1 year, 75% of the treated Soviet patients had DBPs less than 90 mm Hg, whereas only 24% of the American patients had comparable DBPs.

[Use of a psychoemotional test for detecting heart rhythm disorders in patients with various cardiovascular diseases]. / Ispol'zovanie psikhoémotsional'noi proby dlia vyiavleniia narusheniia ritma serdtsa u bol'nykh s razlichnymi serdechno-sosudistymi zabolevaniiami.

Emotional stress was simulated by consecutive exposure to 3 tests in patients with a variety of heart rhythm disorders based on different forms of underlying disease. Arrhythmias were detected in 16.4%, and extrasystoles in 2.6%. The method appears particularly valuable for the diagnosis of arrhythmia in patients with idiopathic heart rhythm disorders and those prone to anxiety and hypochondria.

[Sensitivity to the psycho-emotional test and the characteristics of the psychological status of ischemic heart disease patients]. / Chuvstvitel'nost' k psikhoémotsional'noi probe i osobennosti psikhologicheskogo statusa bol'nykh ishemicheskoi bolezn'iu serdtsa.

Sixty-three coronary patients were subjected to mental testing, using the SMALL test and Kettell's 16 PF test. Positive test results were significantly more frequent in patients of the second and third functional classes with neurotic anxiety-depressive disturbances. In patients of the fourth functional class, the results of the tests were not dependent on their psychological status. Patients with the most marked neurotic disturbances may develop an anginal attack accompanied with ischemic ECG changes during the mental test.

[Effect of a short course of physical training on the mental status of post-myocardial infarct patients]. / Vliianie neprodolzhitel'nogo kursa fizicheskikh trenirovok na psikhicheskoe sostoianie bol'nykh, perenesshikh infarkt miokarda.

The psychological effect of short exercise on a bicycle trainer (30 sessions over 10 weeks) was assessed in 20 postmyocardial infarction patients, while spontaneous mental changes were assessed in 21 untrained controls. Exercise was started 2 to 2.5 months after the attack. Mental states were assessed by the brief multifactorial personality assessment questionary (the BMPAQ test) and the neuroticism scale (NS). Physical exercise contributed to a more rapid psychological rehabilitation, as evidenced by the BMPAQ and NS testing. The mentality of the control patients improved less rapidly as shown by the BMPAQ test, while their NS parameters remained unchanged. Mental parameters of trained and untrained patients were basically similar within 12 months, after myocardial infarction as evidenced by the BMPAQ test.

[Psychological nondrug treatment of hypertension and the criteria of its effectiveness]. / Psikhologicheskoe nemedikamentoznoe lechenie gipertonicheskoi bolezni i kriterii ego éffektivnosti.

Eighty patients with essential hypertension, stages IIA-IIB, were examined three times: on admission to hospital, and 1 and 12 months later. All patients were subjected to clinical, psychological (brief multifactorial questionnaire for examination of a personality and the interpersonal relationships test) and psychophysiological investigation. The patients were allocated to 3 groups by random selection: 30 patients practicing autogenic training (group 1), 30 patients on relaxation therapy making use of biological feedback (BFB) (group 2), and 20 patients exposed to no psychological influences (group 3, or the controls). In the presence of psychological treatment, the BP decline, the increase in stress tolerance and the improvement of the psychological status were significantly more marked in the former two groups, as compared to the controls. Comparative assessment of the efficiency of autogenic training and BFB showed no basic differences between the two treatment methods. In cases where treatment proved inefficient, the patients exhibited a negative attitude to treatment and markedly demonstrative character.

[Psychological and psychophysiological characteristics of arterial hypertension patients]. / Psikhologicheskie i psikhofiziologicheskie osobennosti bol'nykh arterial'noi gipertoniei.

A total of 120 essentially-hypertensive patients and 30 coronary patients were investigated clinically and by means of psychophysiologic and psychological tests. Different patterns of physiological response to psychoemotional stress were demonstrated in hypertensive and coronary patients. The markedness and duration of stress-induced hypertensive response was found to be related to psychosocial status of essentially-hypertensive patients. Hypertensive patients showing high anxiety and high interpersonal and intrapersonal conflict develop more marked blood pressure elevation under stress, a possible evidence of a greater contribution of psychosocial factors to the disease in these patients.

[A school for patients with a history of myocardial infarct and their families: a method of group psychosocial intervention and an assessment of its effectiveness]. / Shkola dlia bol'nykh, perenesshikh infarkt miokarda, i ikh rodstvennikov: metodika gruppovogo psikhosotsial'nogo vmeshatel'stva i otsenka ego éffektivnosti.

A group method of psychosocial intervention (a "school") has been developed for post-myocardial infarction patients and their families in order to build up positive attitudes to medical recommendations. The efficiency of the school as well as the social and psychologic factors involved were assessed using the multifactorial scale of psychosocial changes, and 16PF, and "polar profiles" tests, and Leary's method, in 27 post-myocardial infarction patients (mean age 49.8 years) and their 12 wives. It was demonstrated that the patients' attitudes to medical recommendations became more positive, as compared to a control group; moreover, this positive quality persisted over long-term follow-up. Certain personality features (self-image, psychological makeup) affecting the patient's observance of medical advice were demonstrated which should be considered in planning the rehabilitation strategy for myocardial infarction patients. The results indicate that patients' wives should also be enrolled in the group effort.