Abstract
An intensive 7-week relaxation therapy was evaluated in a sample of unmedicated borderline hypertensive men. All subjects were provided state-of-the-art medical information regarding changes known to affect hypertension favorably, e.g., lower salt intake and regular exercise. In addition, relaxation subjects were trained in muscle relaxation that entailed audiotaped home practice. As predicted, relaxation combined with hygiene lowered blood pressure more than did hygiene alone. Neither treatment favorably affected a paper-and-pencil measure of anger but relaxation did lower anger-hostility on a new cognitive assessment procedure, Articulated Thoughts in Simulated Situations (ATSS). Moreover, ATSS anger-hostility reduction was correlated with blood pressure or heart rate reductions, for all subjects and especially for those in the Relaxation condition. This represents the first clinically demonstrated link between change in a cognitive variable and change in cardiovascular activity. Finally, results were especially strong in subjects high in norepinephrine, suggesting its importance in essential hypertension.
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Achmon, J., Granek, M., Golomb, M., and Hart, J. (1989). Behavioral treatment of essential hypertension: A comparison between cognitive therapy and biofeedback of heart rate.Psychosom. Med. 51: 152–164.
Agras, W. S., Southam, M. A., and Taylor, C. B. (1983). Long-term persistence of relaxation-induced blood pressure lowering during the working day.J. Consult. Clin. Psychol. 51: 792–794.
Alexander, F. (1939). Emotional factors in essential hypertension: Presentation of a tentative hypothesis.Psychosom. Med. 1: 173–179.
Bali, L. R. (1979). Long-term effect of relaxation on blood pressure and anxiety levels of essential hypertensive males: A controlled study.Psychosom. Med. 41: 637–646.
Bandura, A. (1969).Principles of Behavior Modification, Holt, Rinehart & Winston, New York.
Barlow, D. H., Cohen, A. S., Waddell, M. T., Vermilyia, B. B., Klosko, J. S., Blanchard, E. B., and DiNardo, P. A. (1984). Panic and generalized anxiety disorders: Nature and treatment.Behav. Ther. 15: 431–449.
Beck, A. T. (1967).Depression: Clinical, Experimental and Theoretical Aspects, Harper and Row, New York.
Bice, T., Davidson, G. C., and DeQuattro, V. L. (1991). Compliance to relaxation therapy for the treatment of essential hypertension. Unpublished manuscript, University of Southern California, Los Angeles.
Causon, R. C., and Carruthers, M. E. (1982). Measurement of catecholamines in biological fluids by high performance liquid chromatography: A comparison of fluorimetric with electrochemical detection.J. Cheomatogr. 229: 301–309.
Chesney, M. A. (eds.) (1985). Anger and hostility: Future implications for behavioral medicine. In Chesney, M. A., and Rosenman, R. H. (eds.),Anger and Hostility in Cardiovascular and Behavioral Disorders, Hemisphere, New York, pp. 277–290.
Chesney, M. A., and Rosenman, R. H. (eds.) (1985).Anger and Hostility in Cardiovascular and Behavioral Disorders, Hemisphere, New York.
Davison, G. C. (1965). Relative contributions of differential relaxation and graded exposure to in vivo desensitization of a neurotic fear.Proceedings of the 73rd Annual Convention of the American Psychological Association, American Psychological Association, Washington, D.C.
Davison, G. C. (1966a). Anxiety under total curarizalion: Implications for the role of muscular relaxation in the desensitization of neurotic fears.J. Nerv. Ment. Dis. 143: 443–448.
Davison, G. C. (1966b). Differential relaxation and cognitive restructuring in therapy with a “paranoid schizophrenic” or “paranoid state.”Proceedings of the 74th Annual Convention of the American Psychological Association, American Psychological Association, Washington, D.C.
Davison, G. C., Robins, C., and Johnson, M. K. (1983). Articulated thoughts during simulated situations: A paradigm for studying cognition in emotion and behavior.Cognit. Ther. Res. 7: 17–40.
DeBerry, S. (1982). The effects of meditation-relaxation on anxiety and depression in a geriatric population.Psycholher. Theory Res. Pract. 9: 512–521.
Deffenbacher, J. L., Demm, P. M., and Brandon, A. D. (1986). High general anger: Correlates and treatment.Behav. Res. Ther. 4: 481–489.
Diamond, E. L. (1982). The role of anger and hostility in essential hypertension and coronary heart disease.Psychol. Bull. 2: 410–433.
Didion, J. (1979).The White Album, Simon and Schuster, New York.
Dimsdale, J. E., Pierce, C., Schoenfeld, D., Brown, A., Zusman, R., and Graham, R. (1986). Suppressed anger and blood pressure: The effects of race, sex, social class, obesity, and age.Psychosom. Med. 48: 430–436.
DiTomasso, R. A. (1987). Essential hypertension: A methodological review. In Michelson, L., and Ascher, L. M. (eds.),Anxiety and Stress Disorders: Cognitive-Behavioral Assessment and Treatment, Guilford Press, New York, pp. 520–582.
Ellis, A. (1962).Reason and Emotion in Psychotherapy, Lyle Stuart, New York.
Eriksson, B. M., and Persson, B. A. (1982). Determination of catecholamines in rat heart tissue and plasma samples by liquid chromatography with electrochemical detection.J. Chromatogr. 228: 143–154.
Esler, M., Julius, S., Zweifler, A., Randall, O., Harburg, E., Gardiner, H., and DeQuattro, V. (1977). Mild high-renin essential hypertension: Neurogenic human hypertension?N. Engl. J. Med. 296: 405–411.
Friedman, M., Thoresen, C. E., Gill, J. J., Ulmer, D., Thompson, L., Powell, L., Price, A., Elek, S. R., Rabin, D. D., Breall, J. S., Piaget, G., Dixon, T., Bourg, E., Levy, R., and Tasto, D. I. (1982). Feasibility of altering Type A behavior pattern after myocardial infarction.Circulation 66: 83–92.
Geer, J. H., Davison, G. C., and Gatchel, R. I. (1970). Reduction of stress in humans through nonveridical perceived control of aversive stimulation.J. Personal. Soc. Psychol. 16: 731–738.
Gentry, W. D., Chesney, A. P., Gary, H. E., Hall, R. P., and Harburg, E. (1982). Habitual anger-coping styles. I. Effect on mean blood pressure and risk for essential hypertension.Psychosom. Med. 44: 195–202.
Glass, D. C., Singer, J. E., Leonard, H. S., Krantz, D. S., Cohen, S., and Cummings, H. (1973). Perceived control of aversive stimulation and the reduction of stress responses.J. Personal. 41: 577–595.
Goldfried, M. R., and Davison, G. C. (1976).Clinical Behavior Therapy, Holt, Rinehart and Winston, New York.
Harburg, E., Erfurt, J. C., Hauenstein, L. S., Chape, C., Schull, W. J., and Schork, M. A. (1973). Socio-ecological stress, suppressed hostility, skin color, and black-white male blood pressure: Detroit.Psychosom. Med. 35: 276–295.
Hazaleus, S. L., and Deffenbacher, J. L. (1986). Relaxation and cognitive treatment of anger.J. Consult. Clin. Psychol. 54: 222–226.
Heide, F. J., and Borkovec, T. D. (1984). Relaxation-induced anxiety: Mechanisms and theoretical implications.Behav. Res. Ther. 22: 1–12.
Hoelscher, T. J., Lichstein, K. L., and Rosenthal, T. L. (1986). Home relaxation practice in hypertensive treatment: Objective assessment and compliance induction.J. Consult. Clin. Psychol. 4: 217–221.
Hokanson, J. E., and Burgess, M. (1962). The effects of status, type of frustration, and aggression on vascular process.J. Abnorm. Soc. Psychol. 65: 232–237.
Jacobson, E. (1929).Progressive Relaxation, University of Chicago Press, Chicago.
Johnston, D. W. (1985). Psychological interventions in cardiovascular disease.J. Psychosom. Res. 29: 447–456.
Lazarus, R. S. (1966).Psychological Stress and the Coping Process, McGraw-Hill, New York.
Lee, D. D., DeQuattro, V., Allen, J., Kimura, S., Aleman, E., Konugres, G., and Davison, G. C. (1988). Behavioral vs. beta-blocker therapy in patients with primary hypertension: Effects on blood pressure, left ventricular function and mass, and the pressor surge of social stress anger.Am. Heart J. 116: 637–644.
Lehrer, P. M., Woolfolk, R. L., Rooney, A. J., McCann, B., and Carrington, P. (1983). Progressive relaxation and meditation: A study of psychophysiological and therapeutic differences between two techniques.Behav. Res. Ther. 21: 651–662.
London, P. (1964).The Modes and Morals of Psychotherapy, Holt, Rinehart & Winston, New York.
London, P. (1985).The Modes and Morals of Psychotherapy, 2nd ed., Hemisphere, New York.
Mahoney, M. J. (1974).Cognition and Behavior Modification, Ballinger, Cambridge, Mass.
Megargee, E. I. (1985). The dynamics of aggression and their application to cardiovascular disorders. In Chesney, M. A., and Rosenman, R. H. (eds.),Anger and Hostility in Cardiovascular and Behavioral Disorders, Hemisphere, New York, pp. 31–57.
Novaco, R. W. (1985). Anger and its therapeutic regulation. In Chesney, M. A., and Rosenman, R. H. (eds.),Anger and Hostility in Cardiovascular and Behavioral Disorders, Hemisphere, New York, pp. 203–226.
Sanderson, W. C., Rapee, R. M., and Barlow, D. H. (1989). The influence of an illusion of control on panic attacks induced via inhalation of 5.5% carbon dioxide-enriched air.Arch. Gen. Psychiat. 46: 157–162.
Schwartz, G. E., Davidson, R. J., and Goleman, D. (1978). Patterning of cognitive and somatic processes in the self-regulation of anxiety: Effects of meditation versus exercise.Psychosom. Med. 40: 321–328.
Seer, P. (1979). Psychological control of essential hypertension: Review of the literature and methodological critique.Psychol. Bull. 86: 1015–1043.
Spielberger, C. D., Gorsuch, R. L., and Lushene, R. E. (1970).Manual for the Stait-Trait Anxiety Inventory, Consulting Psychologists Press, Palo Alto, Calif.
Spielberger, C. D., Jacobs, G., Russell, S. F., and Crane, R. J. (1983). Assessment of anger: The State-Trait Anger Scale. In Butcher, J. N., and Spielberger, C. D. (eds.),Advances in Personality Assessment, Vol. 2, LEA, Hillsdale, N.J., pp. 159–187.
Spielberger, C. D., Johnson, E. H., Russell, S. F., Crane, R. J., Jacobs, G. A., and Worden, T. J. (1985). The experience and expression of anger: Construction and validation of an anger expression scale. In Chesney, M. A., and Rosenman, R. H. (eds.),Anger and Hostility in Cardiovascular and Behavioral Disorders, Hemisphere, New York, pp. 5–30.
Taylor, C. B., Agras, S., Schneider, J. A., and Allen, R. A. (1983). Adherence to instructions to practice relaxation exercises.J. Consult. Clin. Psychol. 51: 952–953.
Wadden, T. A. (1983). Predicting treatment response to relaxation therapy for essential hypertension.J. Nerv. Ment. Dis. 171: 683–689.
Williams, M. E., Davison, G. C., Nezami, E., and DeQuattro, V. L. (in press). Cognitions of Type A and B individuals in response to social criticism.Cognit. Ther. Res.
Wolpe, J. (1958).Psychotherapy by Reciprocal Inhibition, Stanford University Press, Stanford, Calif.
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This research was supported by Grant RO1 HL31090 from the National Heart, Lung, and Blood Institute.
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Davison, G.C., Williams, M.E., Nezami, E. et al. Relaxation, reduction in angry articulated thoughts, and improvements in borderline hypertension and heart rate. J Behav Med 14, 453–468 (1991). https://doi.org/10.1007/BF00845104
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DOI: https://doi.org/10.1007/BF00845104