Journal of Behavioral Medicine

, Volume 14, Issue 5, pp 453–468 | Cite as

Relaxation, reduction in angry articulated thoughts, and improvements in borderline hypertension and heart rate

  • Gerald C. Davison
  • Marian E. Williams
  • Elahe Nezami
  • Traci L. Bice
  • Vincent L. DeQuattro


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.

Key words

relaxation hypertension anger articulated thoughts cognitive assessment 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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.Google Scholar
  2. 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.Google Scholar
  3. Alexander, F. (1939). Emotional factors in essential hypertension: Presentation of a tentative hypothesis.Psychosom. Med. 1: 173–179.Google Scholar
  4. 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.Google Scholar
  5. Bandura, A. (1969).Principles of Behavior Modification, Holt, Rinehart & Winston, New York.Google Scholar
  6. 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.Google Scholar
  7. Beck, A. T. (1967).Depression: Clinical, Experimental and Theoretical Aspects, Harper and Row, New York.Google Scholar
  8. 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.Google Scholar
  9. 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.Google Scholar
  10. 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.Google Scholar
  11. Chesney, M. A., and Rosenman, R. H. (eds.) (1985).Anger and Hostility in Cardiovascular and Behavioral Disorders, Hemisphere, New York.Google Scholar
  12. 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.Google Scholar
  13. 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.Google Scholar
  14. 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.Google Scholar
  15. 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.Google Scholar
  16. DeBerry, S. (1982). The effects of meditation-relaxation on anxiety and depression in a geriatric population.Psycholher. Theory Res. Pract. 9: 512–521.Google Scholar
  17. Deffenbacher, J. L., Demm, P. M., and Brandon, A. D. (1986). High general anger: Correlates and treatment.Behav. Res. Ther. 4: 481–489.Google Scholar
  18. Diamond, E. L. (1982). The role of anger and hostility in essential hypertension and coronary heart disease.Psychol. Bull. 2: 410–433.Google Scholar
  19. Didion, J. (1979).The White Album, Simon and Schuster, New York.Google Scholar
  20. 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.Google Scholar
  21. 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.Google Scholar
  22. Ellis, A. (1962).Reason and Emotion in Psychotherapy, Lyle Stuart, New York.Google Scholar
  23. 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.Google Scholar
  24. 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.Google Scholar
  25. 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.Google Scholar
  26. 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.Google Scholar
  27. 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.Google Scholar
  28. 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.Google Scholar
  29. Goldfried, M. R., and Davison, G. C. (1976).Clinical Behavior Therapy, Holt, Rinehart and Winston, New York.Google Scholar
  30. 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.Google Scholar
  31. Hazaleus, S. L., and Deffenbacher, J. L. (1986). Relaxation and cognitive treatment of anger.J. Consult. Clin. Psychol. 54: 222–226.Google Scholar
  32. Heide, F. J., and Borkovec, T. D. (1984). Relaxation-induced anxiety: Mechanisms and theoretical implications.Behav. Res. Ther. 22: 1–12.Google Scholar
  33. 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.Google Scholar
  34. 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.Google Scholar
  35. Jacobson, E. (1929).Progressive Relaxation, University of Chicago Press, Chicago.Google Scholar
  36. Johnston, D. W. (1985). Psychological interventions in cardiovascular disease.J. Psychosom. Res. 29: 447–456.Google Scholar
  37. Lazarus, R. S. (1966).Psychological Stress and the Coping Process, McGraw-Hill, New York.Google Scholar
  38. 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.Google Scholar
  39. 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.Google Scholar
  40. London, P. (1964).The Modes and Morals of Psychotherapy, Holt, Rinehart & Winston, New York.Google Scholar
  41. London, P. (1985).The Modes and Morals of Psychotherapy, 2nd ed., Hemisphere, New York.Google Scholar
  42. Mahoney, M. J. (1974).Cognition and Behavior Modification, Ballinger, Cambridge, Mass.Google Scholar
  43. 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.Google Scholar
  44. 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.Google Scholar
  45. 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.Google Scholar
  46. 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.Google Scholar
  47. Seer, P. (1979). Psychological control of essential hypertension: Review of the literature and methodological critique.Psychol. Bull. 86: 1015–1043.Google Scholar
  48. Spielberger, C. D., Gorsuch, R. L., and Lushene, R. E. (1970).Manual for the Stait-Trait Anxiety Inventory, Consulting Psychologists Press, Palo Alto, Calif.Google Scholar
  49. 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.Google Scholar
  50. 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.Google Scholar
  51. 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.Google Scholar
  52. Wadden, T. A. (1983). Predicting treatment response to relaxation therapy for essential hypertension.J. Nerv. Ment. Dis. 171: 683–689.Google Scholar
  53. 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. Google Scholar
  54. Wolpe, J. (1958).Psychotherapy by Reciprocal Inhibition, Stanford University Press, Stanford, Calif.Google Scholar

Copyright information

© Plenum Publishing Corporation 1991

Authors and Affiliations

  • Gerald C. Davison
    • 1
  • Marian E. Williams
    • 1
  • Elahe Nezami
    • 1
  • Traci L. Bice
    • 1
  • Vincent L. DeQuattro
    • 2
  1. 1.Department of PsychologyUniversity of Southern CaliforniaLos Angeles
  2. 2.Department of MedicineUniversity of Southern CaliforniaUSA

Personalised recommendations