Cognitive‐behavioural stress management does not improve biological cardiovascular risk indicators in women with ischaemic heart disease: a randomized‐controlled trial

Claesson, Maria; Birgander, Lisbeth Slunga; Jansson, Jan‐Håkan; Lindahl, Bernt; Burell, Gunilla; Asplund, Kjell; Mattsson, Cecilia

doi:10.1111/j.1365-2796.2006.01691.x

Cited by 27 publications

(22 citation statements)

References 48 publications

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“…119 In contrast, cognitive behavioral stress management had no effect on several hemostasis measures in CHD patients when compared with usual care after 1 year. 121 The systematic provocation of laughter might also benefit low-grade hypercoagulability. 122…”

Section: Results From Intervention Studiesmentioning

confidence: 99%

Stress and Hemostasis: An Update

Austin

Wissmann

Känel

2013

Semin Thromb Hemost

116

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, 62, is one psychoanalyst willing to declare that Richard Nixon's phlebitis is psychosomatic. The man has been under extraordinary pressure for more than a year, Dr. Silverman says. Mr. Nixon seems to keep his emotions under such control that we might have expected physical instead of emotional breakdown.Time Magazine, September 30, 1974, p. 65. This introductory "case vignette" raises the question of whether intense emotional stress, such as experienced by the United States President Nixon in the wake of the Watergate scandal, is capable of causing thrombosisassociated diseases and, if so, by which mechanisms. Thus, the aim of this review is to provide an update on the sizeable literature on stress-related changes in the Keywords ► blood coagulation ► fibrinolysis ► platelets ► psychological stress ► risk factor AbstractNumerous naturalistic, experimental, and mechanistic studies strongly support the notion that-as part of fight-or-flight response-hemostatic responses to acute psychosocial stress result in net hypercoagulability, which would protect a healthy organism from bleeding in case of injury. Sociodemographic factors, mental states, and comorbidities are important modulators of the acute prothrombotic stress response. In patients with atherosclerosis, exaggerated and prolonged stress-hypercoagulability might accelerate coronary thrombus growth following plaque rupture. Against a background risk from acquired prothrombotic conditions and inherited thrombophilia, acute stress also might trigger venous thromboembolic events. Chronic stressors such as job strain, dementia caregiving, and posttraumatic stress disorder as well as psychological distress from depressive and anxiety symptoms elicit a chronic low-grade hypercoagulable state that is no longer viewed as physiological but might impair vascular health. Through activation of the sympathetic nervous system, higher order cognitive processes and corticolimbic brain areas shape the acute prothrombotic stress response. Hypothalamic-pituitary-adrenal axis and autonomic dysfunction, including vagal withdrawal, are important regulators of hemostatic activity with longer lasting stress. Randomized placebo-controlled trials suggest that several cardiovascular drugs attenuate the acute prothrombotic stress response. Behavioral interventions and psychotropic medications might mitigate chronic low-grade hypercoagulability in stressed individuals, but further studies are clearly needed. Restoring normal hemostatic function with biobehavioral interventions bears the potential to ultimately decrease the risk of thrombotic diseases. hemostatic system (i.e., coagulation, fibrinolysis, and platelets) and their potential role in thrombosis. As a prerequisite for the notion that stress-associated hypercoagulability contributes to thrombotic events, 1 abundant epidemiological and experimental data exist supporting the role of enhanced coagulation, impaired fibrinolysis, and hyperactive platelets in the development of atherogenesis, atherothrombosis, and acute coronary...

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Section: Results From Intervention Studiesmentioning

confidence: 99%

Stress and Hemostasis: An Update

Austin

Wissmann

Känel

2013

Semin Thromb Hemost

116

View full text Add to dashboard Cite

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“…This homework can entail practicing problem-solving techniques, keeping a diary, practicing relaxation or participating in physical activities. Each group meeting has a specific subject, derived from the 6 components in the intervention [24]. These components concern 1) basic knowledge about cancer, treatment, healthy living and stress reactions, 2) self-awareness with the help of a diary for thoughts, feelings and behavior, as well as group discussions of specific cases 3) instruction in various techniques about how to express negative feelings, how to communicate with others more effectively how to change behaviors related to stress, anger, worry and depression 4) training these techniques in real-life situations outside the group, 5) cognitive restructuring with the help of diaries, techniques and group dynamics and 6) spirituality, in a broad sense, with group discussions of quality of life, values, self-confidence and optimism.…”

Section: Methodsmentioning

confidence: 99%

Design of the study: How can health care help female breast cancer patients reduce their stress symptoms? A randomized intervention study with stepped-care

et al. 2012

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BackgroundA life threatening illness such as breast cancer can lead to a secondary diagnosis of PTSD (post traumatic stress disorder) with intrusive thoughts and avoidance as major symptoms. In a former study by the research group, 80% of the patients with breast cancer reported a high level of stress symptoms close to the diagnosis, such as intrusive thoughts and avoidance behavior. These symptoms remained high throughout the study. The present paper presents the design of a randomized study evaluating the effectiveness and cost-effectiveness of a stress management intervention using a stepped-care design.MethodFemale patients over the age of 18, with a recent diagnosis of breast cancer and scheduled for adjuvant treatment in the form of chemotherapy, radiation therapy and/or hormonal therapy are eligible and will consecutively be included in the study. The study is a prospective longitudinal intervention study with a stepped-care approach, where patients will be randomised to one of two interventions in the final stage of treatment. The first step is a low intensity stress-management intervention that is given to all patients. Patients who do not respond to this level are thereafter given more intensive treatment at later steps in the program and will be randomized to more intensive stress-management intervention in a group setting or individually. The primary out-come is subjective distress (intrusion and avoidance) assessed by the Impact of Event Scale (IES). According to the power-analyses, 300 patients are planned to be included in the study and will be followed for one year. Other outcomes are anxiety, depression, quality of life, fatigue, stress in daily living and utilization of hospital services. This will be assessed with well-known psychometric tested questionnaires. Also, the cost-effectiveness of the intervention given in group or individually will be evaluated.DiscussionThis randomized clinical trial will provide additional empirical evidence regarding the effectiveness of a stress-management program given in group or individually during adjuvant therapy in terms of decreased stress, minimizing fatigue, and maintaining or enhancing patients’ quality of life and psychological well-being.Trial registrationClinicalTrials.gov Identifier: NCT01555645

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“…A 10-week CBSM intervention improved lymphocyte proliferative responses at the three-month follow-up in women with early-stage breast cancer (McGregor et al, 2004) and favorably changed the distribution of CD4 (helper T cells) and CD8 (suppressor or cytotoxic T cells) lymphocyte subsets in men with HIV (Antoni, 2003). However, other investigators found no significant changes in other physiologic responses (e.g., C-reactive protein) to CBSM in women with ischemic heart disease (Claesson et al, 2006;Claesson et al, 2005).…”

Section: Stress Management Adherence and Immune Responsesmentioning

confidence: 97%

“…A number of stress management programs have been implemented in various populations, but their impacts on immune responses have not been uniform. For example, cognitive-behavior stress management (CBSM) is one of the most widely used programs (Antoni, 2003;Antoni et al, 2001;Claesson et al, 2006;Claesson et al, 2005;Cruess et al, 2000;McGregor et al, 2004). A 10-week CBSM intervention improved lymphocyte proliferative responses at the three-month follow-up in women with early-stage breast cancer (McGregor et al, 2004) and favorably changed the distribution of CD4 (helper T cells) and CD8 (suppressor or cytotoxic T cells) lymphocyte subsets in men with HIV (Antoni, 2003).…”

Section: Stress Management Adherence and Immune Responsesmentioning

confidence: 99%