New approaches to the management of essential hypertension with psychological techniques

Abstract

SUMMARY The treatment of high blood pressure using psychological techniques such as biofeedback and relaxation or meditation has met with only limited success so far, and has yet to expand beyond experimental and research settings. This may be partly due to the small size of changes produced in many studies, but also because poor methodology has hindered interpretation of results. In particular, the adaptation of patients to the clinic or laboratory, and the influence of non-specific factors deserve careful consideration by investigators. It is suggested that the size of pressure modifications might be enhanced by introducing treatment at the stages in the development of the disorder that are characterised by high levels of autonomic activity. Recent haemodynamic studies indicate that this condition is fulfilled less by established hypertension than by the early or borderline phases. Similarly, training should be associated with conditions in which psychosicial influences on the cardiovascular system are prominent. It is apparent that high pressure episodes are produced through the imposition of taxing or distressing psychosocial stimuli in both animals and man. It may be worthwhile therefore, to help people to overcome reactions to psychological stressors directly; hitherto, biofeedback and relaxation have been used to reduce the tonic pressure levels of resting subjects. Date from two experiments that illustrate this approach will be described. Both were comparisons of the pressure reductions produced with feedback or relaxation instructions amongst normotensives. In each case, training was carried out while subjects were performing distracting tasks; the particular portions of the studies that will be discussed involved mental arithmetic and auditory reaction time tests. The results suggest that biofeedback leads to more effective control of blood pressure response to the tasks, and to some ability to reduce pressor reactions. In contrast, when training was carried out under conventional resting conditions, the modifications seen with the two techniques were identical. The value of these methods may be enhanced by actively engaging patients in their own treatment and by incorporating selfcontrol techniques into a more general programme of behaviour change. Thus simultaneously, energies should be directed towards modifying smoking, diet, level of exercise and other factors likely to reduce risks of cardiovascular disease. Within such a framework, training in the voluntary control of blood pressure may play an important part.