1
|
Park M. Evidence-based stress management: focusing on nonpharmacological procedure which reduce stress and promote health. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.6.478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Minseon Park
- Department of Family Medicien, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
2
|
Matteson-Rusby SE, Pigeon WR, Gehrman P, Perlis ML. Why treat insomnia? PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12:PCC.08r00743. [PMID: 20582296 PMCID: PMC2882812 DOI: 10.4088/pcc.08r00743bro] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 03/06/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To make the case that insomnia is better conceptualized, not as a symptom, but as a primary disorder. DATA SOURCES PubMed was searched from 1975-2009 using the search terms insomnia, insomnia and treatment, insomnia and cost, and insomnia and treatment and safety. STUDY SELECTION English-language articles and other materials were selected to address the following claims: insomnia is unremitting, insomnia is disabling, insomnia is costly, insomnia is pervasive, insomnia is pernicious, and insomnia treatment is safe and effective. DATA EXTRACTION/SYNTHESIS Insomnia, at least when chronic, should be conceptualized as a comorbid condition, one for which effective interventions are available. CONCLUSIONS It is speculated that treatment for insomnia will only become the norm when it has been demonstrated that treatment not only addresses the problem of insomnia but also serves to reduce medical and psychiatric morbidity. At that time, the question will no longer be "Why treat insomnia?" but instead "When isn't insomnia treatment indicated?"
Collapse
Affiliation(s)
- Sara E Matteson-Rusby
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester, New York and Behavioral Sleep Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia
| | | | | | | |
Collapse
|
3
|
Thorp SR, Ayers CR, Nuevo R, Stoddard JA, Sorrell JT, Wetherell JL. Meta-analysis comparing different behavioral treatments for late-life anxiety. Am J Geriatr Psychiatry 2009; 17:105-15. [PMID: 19155744 PMCID: PMC2794407 DOI: 10.1097/jgp.0b013e31818b3f7e] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of different types of behavioral treatments for geriatric anxiety (cognitive behavior therapy [CBT] alone, CBT with relaxation training [RT], and RT alone). METHOD The authors compared effect sizes from 19 trials. Analyses were based on uncontrolled outcomes (comparing posttreatment and pretreatment scores) and effects relative to control conditions on both anxiety and depressive symptoms. RESULTS Treatments for older adults with anxiety symptoms were, on average, more effective than active control conditions. Effect sizes were comparable to those reported elsewhere for CBT for anxiety in the general population or for pharmacotherapy in anxious older adults. CBT (alone or augmented with RT) does not seem to add anything beyond RT alone, although a direct comparison is challenging given differences in control conditions. Effects on depressive symptoms were smaller, with no differences among treatment types. CONCLUSION Results suggest that behavioral treatments are effective for older adults with anxiety disorders and symptoms. Results must be interpreted with caution given the limitations of the literature, including differing sample characteristics and control conditions across studies.
Collapse
Affiliation(s)
- Steven R. Thorp
- UCSD Department of Psychiatry and VA San Diego Healthcare System
| | | | | | - Jill A. Stoddard
- UCSD Department of Psychiatry and VA San Diego Healthcare System
| | | | | |
Collapse
|
4
|
Abstract
Anxiety is a significant problem among the elderly. Due to complexities in the medical management of elderly patients, researchers and clinicians have sought psychosocial alternatives to pharmacotherapy in order to treat anxiety in the elderly. Cognitive-behavioral therapy (CBT) in particular has been investigated as a promising treatment. Research conducted to date has established that CBT produces significant improvement in anxiety symptoms among the elderly. However, there is some concern that CBT does not benefit elderly anxiety patients as much as it does younger patients. Investigators are seeking methods of augmenting or supplementing CBT in order to develop more effective treatments for anxiety in the elderly.
Collapse
Affiliation(s)
- Ethan E Gorenstein
- Behavioral Medicine Program, Department of Psychiatry, Columbia University, 622 West 168th Street, New York, NY 10032, USA.
| | | |
Collapse
|
5
|
Bormann JE, Becker S, Gershwin M, Kelly A, Pada L, Smith TL, Gifford AL. Relationship of frequent mantram repetition to emotional and spiritual well-being in healthcare workers. J Contin Educ Nurs 2006; 37:218-24. [PMID: 17004395 DOI: 10.3928/00220124-20060901-02] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Healthcare workers report high levels of stress in the workplace. To determine how to reduce stress, the authors examined the effectiveness of frequently repeating a mantram (a word with spiritual meaning) on emotional and spiritual well-being. METHODS A pretest-posttest design was used to measure stress, state/trait anxiety and anger, quality of life, and spiritual well-being in a convenience sample (N=42) of hospital workers completing a mantram intervention program. RESULTS Significant improvements were found in stress (p < .001), trait-anxiety (p = .002), trait-anger (p = .02), quality of life (p = .001), and spiritual well-being (p = .003). When examining the effects of mantram practice, trait-anxiety and religious and spiritual well-being were significant (p < .05). CONCLUSION Improvements in emotional and spiritual well-being may be mediated by frequent mantram repetition.
Collapse
|
6
|
|
7
|
Rausch SM, Gramling SE, Auerbach SM. Effects of a single session of large-group meditation and progressive muscle relaxation training on stress reduction, reactivity, and recovery. INTERNATIONAL JOURNAL OF STRESS MANAGEMENT 2006. [DOI: 10.1037/1072-5245.13.3.273] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
8
|
Abstract
In this study, we extended previous research by concentrating on sleep- and grief-related symptoms in a cohort of bereaved college students, in view of the potential for each of these problems to exacerbate the other. A sample of 815 college students completed the Inventory of Complicated Grief (H. G. Prigerson & S. C. Jacobs, 2001), along with an assessment of diagnostic criteria for insomnia and associated sleep behaviors. As predicted, the rate of insomnia was significantly higher (22%) in the bereaved sample than in a nonbereaved comparison group (17%), a difference that was particularly pronounced in terms of middle insomnia. Also as hypothesized, bereaved insomniacs reported higher complicated grief scores than bereaved noninsomniacs, and several specific sleep variables (including sleep-onset insomnia related to nighttime rumination about the loss and sleep-maintenance insomnia associated with dreaming of the deceased) were significantly related to complicated grief symptomatology.
Collapse
|
9
|
Wetherell JL, Sorrell JT, Thorp SR, Patterson TL. Psychological interventions for late-life anxiety: a review and early lessons from the CALM study. J Geriatr Psychiatry Neurol 2005; 18:72-82. [PMID: 15911935 DOI: 10.1177/0891988705276058] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors review the literature on psychological treatment for anxiety in older adults, focusing on randomized, controlled trials. Evidence exists for the efficacy of relaxation training for subjective anxiety symptoms and cognitive-behavioral therapy for generalized anxiety disorder and miscellaneous anxiety syndromes, including panic disorder. The authors also present the rationale for the CALM Study (Controlling Anxiety in Later-life Medical Patients), an ongoing randomized trial in which a modular psychotherapeutic intervention for anxiety in older primary care patients is compared with treatment as usual. Data are presented from 2 pilot patients in the CALM Study, and preliminary lessons are discussed.
Collapse
|
10
|
Jorm AF, Christensen H, Griffiths KM, Parslow RA, Rodgers B, Blewitt KA. Effectiveness of complementary and self-help treatments for anxiety disorders. Med J Aust 2004; 181:S29-46. [PMID: 15462640 DOI: 10.5694/j.1326-5377.2004.tb06352.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 02/27/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders. DATA SOURCES Systematic literature search using PubMed, PsycLit, and the Cochrane Library. DATA SYNTHESIS 108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies. CONCLUSIONS The treatments with the best evidence of effectiveness are kava (for generalised anxiety), exercise (for generalised anxiety), relaxation training (for generalised anxiety, panic disorder, dental phobia and test anxiety) and bibliotherapy (for specific phobias). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety; for inositol in the treatment of panic disorder and obsessive-compulsive disorder; and for alcohol avoidance by people with alcohol-use disorders to reduce a range of anxiety disorders.
Collapse
Affiliation(s)
- Anthony F Jorm
- Centre for Mental Health Research, Australian National University, Building 63, Eggleston Road, Acton, ACT 0200, Australia.
| | | | | | | | | | | |
Collapse
|
11
|
Nordhus IH, Pallesen S. Psychological treatment of late-life anxiety: an empirical review. J Consult Clin Psychol 2003; 71:643-51. [PMID: 12924668 DOI: 10.1037/0022-006x.71.4.643] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study provides a meta-analytic review of nonpharmacological interventions for late-life anxiety, focusing on treatment efficacy. Included in the analysis are studies in which a comparison was made either to a control condition or to another treatment. A total of 15 outcome studies, published or reported between January 1975 and January 2002, were identified involving 495 participants (mean age exceeding 55.0 years and a grand mean of 69.5 years) and providing 20 separate treatment interventions. The analysis indicated that psychological interventions were reliably more effective than no treatment on self-rated and clinician-rated measures of anxiety, yielding an effect size of .55. Maintenance of treatment gains (a minimum of 6 months follow-up) was insufficiently reported across studies to allow for a reliable demonstration of an overall estimate of long-term efficacy. It is concluded that psychological interventions produce significant improvements, but the analyses must be qualified by data limitations in the research synthesis.
Collapse
|
12
|
Abstract
Formal diagnostic systems (DSM-IV, ICSD, and ICD-10) do not provide adequate quantitative criteria to diagnose insomnia. This may not present a serious problem in clinical settings where extensive interviews determine the need for clinical management. However, lack of standard criteria introduce disruptive variability into the insomnia research domain. The present study reviewed two decades of psychology clinical trials for insomnia to determine common practice with regard to frequency, severity, and duration criteria for insomnia. Modal patterns established frequency (> or =3 nights a week) and duration (> or =6 months) standard criteria. We then applied four versions of severity criteria to a random sample and used sensitivity-specificity analyses to identify the most valid criterion. We found that severity of sleep onset latency or wake time after sleep onset of: (a) > or =31 min; (b) occurring > or =3 nights a week; (c) for > or =6 months are the most defensible quantitative criteria for insomnia.
Collapse
Affiliation(s)
- K L Lichstein
- Department of Psychology, University of Memphis, TN 38152-3230, USA.
| | | | | | | | | |
Collapse
|
13
|
Wilk C, Turkoski B. Progressive muscle relaxation in cardiac rehabilitation: a pilot study. Rehabil Nurs 2001; 26:238-42; discussion 243. [PMID: 12035725 DOI: 10.1002/j.2048-7940.2001.tb01963.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Learning to manage stress is an important lifestyle change for participants in cardiac rehabilitation programs. Progressive muscle relaxation (PMR) is one stress management approach that has produced positive benefits among different patient populations. The purpose of this study was to identify the effects of learning and practicing PMR in a population of cardiac rehabilitation patients. Blood pressure and heart rate data, and scores on the Spielberger State-Trait Anxiety Inventory (STAI) were collected from a treatment group and a control group of patients enrolled in phases II and III of cardiac rehabilitation. Analysis of the data revealed positive effects of PMR on the variables heart rate and state of anxiety. In addition, written evaluations of PMR from patients in the treatment group indicated a high degree of subjective satisfaction with PMR as a means to reduce stress in their lives.
Collapse
Affiliation(s)
- C Wilk
- Kent State University College of Nursing, PO Box 5190, Kent, OH 44242, USA.
| | | |
Collapse
|
14
|
Barrowclough C, King P, Colville J, Russell E, Burns A, Tarrier N. A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. J Consult Clin Psychol 2001; 69:756-62. [PMID: 11680552 DOI: 10.1037/0022-006x.69.5.756] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors used a randomized trial to compare cognitive-behavioral therapy (CBT) and supportive counseling (SC) in the treatment of anxiety symptoms in older adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.: American Psychiatric Association, 1994) criteria for anxiety disorders. Both conditions had a 6-week baseline no-treatment phase. Treatment was delivered primarily in patients' own homes and in an individual format. Outcomes were assessed at posttreatment and at 3-, 6-, and 12-month follow-ups. There was no spontaneous improvement during the baseline phase. Both groups showed improvement on anxiety measures following treatment, with a better outcome for the CBT group on self-rating of anxiety and depression. Over the follow-up period, the CBT group maintained improvement and had significantly greater improvement than the SC group on anxiety and 1 depression measure. Treatment response for anxiety was also superior for the CBT group, although there was no difference between groups in endstate functioning.
Collapse
Affiliation(s)
- C Barrowclough
- Academic Division of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, England.
| | | | | | | | | | | |
Collapse
|
15
|
McCrae CS, Lichstein KL. Secondary insomnia: diagnostic challenges and intervention opportunities. Sleep Med Rev 2001; 5:47-61. [PMID: 12531044 DOI: 10.1053/smrv.2000.0146] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The assessment and treatment of secondary insomnia (SI), the most common form of insomnia, are often complicated. Establishing an accompanying disorder as causal rather than comorbid is the key to assessment, but can be difficult even for experienced clinicians. Treatment often focuses on the primary disorder. In many cases, however, there is reason to treat the insomnia directly (insomnia is partially independent, does not respond to treatment of the primary condition, or has been misdiagnosed as SI). Although hypnotic medications are frequently used, behavioral interventions may be the best treatment approach, providing better long-term management of symptoms. Older adults warrant special consideration as age-related illnesses, changes in drug absorption and metabolism, and polypharmacy make them especially susceptible to SI. Recent research suggests successful treatment of insomnia may also relieve the primary disorder and merits follow-up. Future research is also needed on the efficacy of psychological treatment for SI for specific disorders as well as for older adults.
Collapse
Affiliation(s)
- Christina S. McCrae
- Sleep Research Project, Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | | |
Collapse
|
16
|
Floyd JA, Falahee ML, Fhobir RH. Creation and analysis of a computerized database of interventions to facilitate adult sleep. Nurs Res 2000; 49:236-41. [PMID: 10929696 DOI: 10.1097/00006199-200007000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although sleep problems are a frequent complaint of ill and older adults, there is no ready source of continually updated scientific knowledge about sleep promotion interventions used by nurses. OBJECTIVES To create a database of sleep promotion research and to describe the nature and strength of studies about nursing interventions used to promote sleep in adults. METHODS Computer, hand, ancestry, and author searches were used to identify nursing and related-discipline studies of sleep promotion in adults. An experimental software program, arcs, was used to store, retrieve, examine, and summarize sleep research findings. RESULTS Twelve interventions within the basic scope of nursing practice were identified. All were nonpharmacologic. Interventions were grouped according to their presumed mechanism of action: 1) to relax the sleeper, 2) to manage noise, 3) to re-pattern the sleep-wake schedule, or 4) to inform the sleeper about sleep hygiene. CONCLUSIONS The research base underpinning sleep promotion practices in nursing is sparse. The use of relaxation approaches to promote sleep in those with chronic insomnia has the most support. Extensive research involving other interventions and populations is needed. As more studies become available, they can be added to the computer database, thus facilitating dissemination of scientific knowledge to guide nursing practice.
Collapse
Affiliation(s)
- J A Floyd
- Wayne State University College of Nursing, Detroit, Michigan, USA
| | | | | |
Collapse
|
17
|
Arena JG, Hannah SL, Bruno GM, Meador KJ. Electromyographic biofeedback training for tension headache in the elderly: a prospective study. BIOFEEDBACK AND SELF-REGULATION 1991; 16:379-90. [PMID: 1760459 DOI: 10.1007/bf00999991] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study evaluated the effects of a 12-session frontal electromyographic biofeedback training regimen on the headache activity of eight tension headache sufferers aged 62 and older. The biofeedback sessions were slightly modified for a geriatric population, essentially to increase comprehension and retention of rationale and instructions. Post-treatment assessment at three months revealed significant decreases in overall headache activity (50% or greater) in 50% of the subjects, and moderate improvement (35%-45%) in three of the remaining four subjects. Significant clinical and/or statistical pre-post differences were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of biofeedback training for tension headache in an elderly population and, unlike previous retrospective studies, suggests that such therapy may be an effective intervention in the treatment of tension headaches in the elderly.
Collapse
Affiliation(s)
- J G Arena
- Biofeedback and Psychophysiological Disorders Clinic, Veterans Affairs Medical Center, Augusta, Georgia 30910
| | | | | | | |
Collapse
|
18
|
Kabela E, Blanchard EB, Appelbaum KA, Nicholson N. Self-regulatory treatment of headache in the elderly. BIOFEEDBACK AND SELF-REGULATION 1989; 14:219-28. [PMID: 2688751 DOI: 10.1007/bf01000095] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We examined the utility of various combinations of relaxation, cognitive coping, and feedback in an uncontrolled series of 16 older headache patients (aged 60 to 77) diagnosed as having tension, mixed, or migraine headache. At 1-month follow-up, statistically and clinically significant reductions were observed in both overall headache activity and medication intake; 10 patients (63%) were more than 50% improved in both headache reduction and medication reduction. Female headache suffers were more improved than males. These results are inconsistent with our past findings with geriatric headache sufferers but consistent with other, more recent favorable findings. The efficacy of nondrug treatment for geriatric headache clearly warrants further attention.
Collapse
Affiliation(s)
- E Kabela
- State University of New York, Albany
| | | | | | | |
Collapse
|
19
|
Abstract
It is argued that personality scales of neuroticism and anxiety are tapping the same personality trait and that this is a risk factor for neurotic disorders. To see whether this trait is modifiable, a meta-analysis was carried out of therapy outcome studies which included a measure of trait anxiety or neuroticism as a dependent measure. This meta-analysis showed that all psychological therapies are to some extent effective. However, rational-emotive and related therapies produced particularly large reductions in trait anxiety/neuroticism (around 1.25 standard deviations). The possibility that rational-emotive education programmes could be used to lower trait anxiety/neuroticism as a preventive measure is discussed.
Collapse
Affiliation(s)
- A F Jorm
- NH&MRC Social Psychiatry Research Unit, Australian National University, Canberra
| |
Collapse
|
20
|
Mosher-Ashley PM. Procedural and methodological parameters in behavioral-gerontological research: a review. Int J Aging Hum Dev 1987; 24:189-229. [PMID: 3298076 DOI: 10.2190/2b3t-7rfn-aym7-c4gg] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This article analyzes the behavioral-gerontological research published before 1984. The 151 studies located were classified into three main categories: observation, assessment, and intervention. Each study and each category were examined for variations in the behavioral procedures employed, and in the scientific research methods used to collect and analyze data. The survey indicated several serious problems in the research. Much of the behavioral-gerontological research focuses on institutionalized elderly, and tends to perpetuate a passive, helpless role on the part of the elderly in the treatment process. Less than 20 percent of the studies focused on observation or assessment, and most of these were found to be flawed. The intervention studies were also problematic; the majority of them were of short duration and had only one treatment phase which did not vary substantially during the study period. Most also failed to provide for interobserver agreement, generalization, maintenance, and follow-up assessments. Finally, the implications of these findings for future psychological research with the elderly are discussed.
Collapse
|