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Applied Psychophysiology and Biofeedback

, Volume 35, Issue 2, pp 163–170 | Cite as

Internet-Based Biofeedback-Assisted Relaxation Training in the Treatment of Hypertension: A Pilot Study

  • Erik M. G. OlssonEmail author
  • Samir El Alaoui
  • Bo Carlberg
  • Per Carlbring
  • Ata Ghaderi
Article

Abstract

The effectiveness of biofeedback-assisted behavioral treatment with Internet-based client-therapist contact for hypertension was tested in outpatient settings. A pilot study with a randomized controlled design was adopted with two conditions (treatment versus passive controls), lasting for 8 weeks. There were two assessment time points (pre-treatment and post-treatment) measuring clinic systolic and diastolic blood pressure (SBP and DBP) and administration of a questionnaire collecting demographic and subjective data. Participants included 19 Swedish adults diagnosed with hypertension. The treatment group lowered their SBP 5.9 mm Hg and their DBP 7.6 mm Hg while the control group lowered their SBP 0.8 mm Hg and DBP 3.0 mm Hg. The effect of treatment was significant for DBP but not for SBP. There were no other significant effects of treatment. This pilot study shows encouraging results regarding Internet-based biofeedback treatment for hypertensive adults. However, further research using a larger sample is needed.

Keywords

Biofeedback Internet Blood pressure Hypertension Relaxation 

References

  1. Altunkan, S., Iliman, N., & Altunkan, E. (2008). Validation of the Omron M6 (HEM-7001-E) upper arm blood pressure measuring device according to the international protocol in elderly patients. Blood Pressure Monitoring, 13(2), 117–122.CrossRefPubMedGoogle Scholar
  2. Ambrosioni, E. (2001). Pharmacoeconomic challenges in disease management of hypertension. Journal of Hypertension, 19(3), S33–S40.PubMedGoogle Scholar
  3. Andersson, G., Carlbring, P., Berger, T., Almlov, J., & Cuijpers, P. (2009). What makes Internet therapy work? Cognitive Behaviour Therapy, 38(S1), 55–60.CrossRefGoogle Scholar
  4. Blanchard, E. B., & Devineni, T. (2005). A randomized controlled trial of an internet-based treatment for chronic headache. Behaviour Research and Therapy, 43(3), 277–292.CrossRefPubMedGoogle Scholar
  5. Blanchard, E. B., Andrasik, F., Neff, D. F., Teders, S. J., Pallmeyer, T. P., Arena, J. G., et al. (1982). Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or, the machines may be necessary some of the time. Behaviour Research and Therapy, 20(5), 469–481.CrossRefPubMedGoogle Scholar
  6. Blumenthal, J. A., Sherwood, A., Gullette, E. C., Georgiades, A., & Tweedy, D. (2002). Biobehavioral approaches to the treatment of essential hypertension. Journal of Consulting and Clinical Psychology, 70(3), 569–589.CrossRefPubMedGoogle Scholar
  7. Carlbring, P., Björnstjerna, E., Bergström, A. F., Waara, J., & Andersson, G. (2007). Applied relaxation: An experimental analogue study of therapist vs. computer administration. Computers in Human Behavior, 23, 2–10.CrossRefGoogle Scholar
  8. Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr., et al. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA, 289(19), 2560–2572.CrossRefPubMedGoogle Scholar
  9. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  10. Cook, N. R., Cohen, J., Hebert, P. R., Taylor, J. O., & Hennekens, C. H. (1995). Implications of small reductions in diastolic blood pressure for primary prevention. Archives of Internal Medicine, 155(7), 701–709.CrossRefPubMedGoogle Scholar
  11. Criqui, M. H., Langer, R. D., Fronek, A., Feigelson, H. S., Klauber, M. R., McCann, T. J., et al. (1992). Mortality over a period of 10 years in patients with peripheral arterial disease. New England Journal of Medicine, 326(6), 381–386.PubMedCrossRefGoogle Scholar
  12. Department of Health Statistics and Informatics. (2008). The global burden of disease: 2004 update. Geneva: World Health Organization.Google Scholar
  13. Ezzati, M., Lopez, A. D., Rodgers, A., Vander Hoorn, S., & Murray, C. J. (2002). Selected major risk factors and global and regional burden of disease. Lancet, 360(9343), 1347–1360.CrossRefPubMedGoogle Scholar
  14. Fagard, R. H., Staessen, J. A., & Thijs, L. (1997). Prediction of cardiac structure and function by repeated clinic and ambulatory blood pressure. Hypertension, 29, 22–29.PubMedGoogle Scholar
  15. Failde, I., & Ramos, I. (2000). Validity and reliability of the SF-36 Health Survey Questionnaire in patients with coronary artery disease. Journal of Clinical Epidemiology, 53(4), 359–365.CrossRefPubMedGoogle Scholar
  16. Holroyd, K. A., Penzien, D. B., Hursey, K. G., Tobin, D. L., Rogers, L., Holm, J. E., et al. (1984). Change mechanisms in EMG biofeedback training: Cognitive changes underlying improvements in tension headache. Journal of Consulting and Clinical Psychology, 52(6), 1039–1053.CrossRefPubMedGoogle Scholar
  17. Jenkins, C. D., Rosenman, R. H., & Zyzanski, S. J. (1974). Prediction of clinical coronary heart disease by a test for the coronary-prone behavior pattern. New England Journal of Medicine, 290(23), 1271–1275.PubMedGoogle Scholar
  18. Kannel, W. B. (1996). Blood pressure as a cardiovascular risk factor: Prevention and treatment. JAMA, 275(20), 1571–1576.CrossRefPubMedGoogle Scholar
  19. Levy, D., Larson, M. G., Vasan, R. S., Kannel, W. B., & Ho, K. K. (1996). The progression from hypertension to congestive heart failure. JAMA, 275(20), 1557–1562.CrossRefPubMedGoogle Scholar
  20. Linden, W., & McGrady, A. (2003). Biobehavioral treatment of essential hypertension biofeedback: A practitioner’s guide (pp. 382–405). New York and London: Guildford Press.Google Scholar
  21. Linden, W., & Moseley, J. V. (2006). The efficacy of behavioral treatments for hypertension. Applied Psychophysiology and Biofeedback, 31(1), 51–63.CrossRefPubMedGoogle Scholar
  22. Lundberg, U. (1980). Type A behavior and its relation to personality variables in Swedish male and female university students. Scandinavian Journal of Psychology, 21, 133–138.CrossRefGoogle Scholar
  23. Mancia, G., Ulian, L., Parati, G., & Trazzi, S. (1994). Increase in blood pressure reproducibility by repeated semi-automatic blood pressure measurements in the clinic environment. Journal of Hypertension, 12, 469–473.PubMedGoogle Scholar
  24. Moser, M. (2005). Are lifestyle interventions in the management of hypertension effective? How long should you wait before starting specific medical therapy? An ongoing debate. Journal of Clinical Hypertension (Greenwich), 7(6), 324–326.CrossRefGoogle Scholar
  25. Nakao, M., Yano, E., Nomura, S., & Kuboki, T. (2003). Blood pressure-lowering effects of biofeedback treatment in hypertension: A meta-analysis of randomized controlled trials. Hypertension Research, 26(1), 37–46.CrossRefPubMedGoogle Scholar
  26. O’Brien, E., Asmar, R., Beilin, L., Imai, Y., Mallion, J., Mancia, G., et al. (2003). European society of hypertension recommendations for conventional, ambulatory and home blood pressure measurement. Journal of Hypertension, 21(5), 821–848.CrossRefPubMedGoogle Scholar
  27. Öst, L. G. (1987). Applied relaxation: Description of a coping technique and review of controlled studies. Behaviour Research and Therapy, 25(5), 397–409.CrossRefPubMedGoogle Scholar
  28. Parati, G., Stergiou, G. S., Asmar, R., Bilo, G., de Leeuw, P., Imai, Y., et al. (2008). European society of hypertension guidelines for blood pressure monitoring at home: A summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. Journal of Hypertension, 26(8), 1505–1526.CrossRefPubMedGoogle Scholar
  29. Patel, C. (1973). Yoga and bio-feedback in the management of hypertension. Lancet, 2(7837), 1053–1055.CrossRefPubMedGoogle Scholar
  30. Patel, C. (1975). 12-Month follow-up of yoga and bio-feedback in the management of hypertension. Lancet, 1(7898), 62–64.CrossRefPubMedGoogle Scholar
  31. Patel, C., & North, W. R. (1975). Randomised controlled trial of yoga and bio-feedback in management of hypertension. Lancet, 2(7925), 93–95.CrossRefPubMedGoogle Scholar
  32. Patel, C., Marmot, M. G., & Terry, D. J. (1981). Controlled trial of biofeedback-aided behavioural methods in reducing mild hypertension. British Medical Journal (Clinical Research Ed.), 282(6281), 2005–2008.CrossRefGoogle Scholar
  33. Ritterband, L. M., Andersson, G., Christensen, H. M., Carlbring, P., & Cuijpers, P. (2006). Directions for the international society for research on internet interventions (ISRII). Journal of Medical Internet Research, 8(3), e23.CrossRefPubMedGoogle Scholar
  34. Schneider, R. H., Alexander, C. N., Staggers, F., Rainforth, M., Salerno, J. W., Hartz, A., et al. (2005). Long-term effects of stress reduction on mortality in persons > or = 55 years of age with systemic hypertension. American Journal of Cardiology, 95(9), 1060–1064.CrossRefPubMedGoogle Scholar
  35. Schulzer, M., & Mancini, G. B. (1996). ‘Unqualified success’ and ‘unmitigated failure’: Number-needed-to-treat-related concepts for assessing treatment efficacy in the presence of treatment-induced adverse events. International Journal of Epidemiology, 25(4), 704–712.CrossRefPubMedGoogle Scholar
  36. Shellenberger, R., & Green, J. (1986). From the ghost in the box to successful biofeedback training. Greeley, CO: Health Psychology Publications.Google Scholar
  37. Stigler, S. M. (1997). Regression towards the mean, historically considered. Statistical Methods in Medical Research, 6(2), 103–114.CrossRefPubMedGoogle Scholar
  38. Sullivan, M., Karlsson, J., & Ware, J. E., Jr. (1995). The Swedish SF-36 Health Survey-I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Social Science and Medicine, 41(10), 1349–1358.CrossRefPubMedGoogle Scholar
  39. Sullivan, M., Karlsson, J., & Taft, C. (2002). SF-36 Hälsoenkät:Svensk Manual och Tolkningsguide [Swedish manual and interpretation guide] (2nd ed.). Gothenburg: Sahlgrenska University Hospital.Google Scholar
  40. The Swedish Council on Technology Assessment in Health Care. (2007). Uppdatering av SBU-rapporten Måttligt förhöjt blodtryck (2004), nr 170/1. Stockholm: Statens beredning för medicinsk utvärdering (SBU).Google Scholar
  41. Vasan, R. S., Beiser, A., Seshadri, S., Larson, M. G., Kannel, W. B., D’Agostino, R. B., et al. (2002). Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA, 287(8), 1003–1010.CrossRefPubMedGoogle Scholar
  42. Ware, J. E., Jr., Gandek, B., Kosinski, M., Aaronson, N. K., Apolone, G., Brazier, J., et al. (1998). The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: Results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 1167–1170.CrossRefPubMedGoogle Scholar
  43. Williams, B., Poulter, N. R., Brown, M. J., Davis, M., McInnes, G. T., Potter, J. F., et al. (2004). British hypertension society guidelines for hypertension management 2004 (BHS-IV): Summary. BMJ, 328(7440), 634–640.CrossRefPubMedGoogle Scholar
  44. Yucha, C. B., & Gilbert, C. (2008). Evidence-based practice in biofeedback and neurofeedback. Wheat Ridge, CO: Association for Applied Psychophysiology and Biofeedback.Google Scholar
  45. Yucha, C. B., Clark, L., Smith, M., Uris, P., LaFleur, B., & Duval, S. (2001). The effect of biofeedback in hypertension. Applied Nursing Research, 14(1), 29–35.CrossRefPubMedGoogle Scholar
  46. Zanchetti, A. (2003). Costs of implementing recommendations on hypertension management given in recent guidelines. Journal of Hypertension, 21(12), 2207–2209.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Erik M. G. Olsson
    • 1
    Email author
  • Samir El Alaoui
    • 1
  • Bo Carlberg
    • 2
  • Per Carlbring
    • 3
  • Ata Ghaderi
    • 1
  1. 1.Department of PsychologyUppsala UniversityUppsalaSweden
  2. 2.Umeå University HospitalUmeåSweden
  3. 3.Department of Behavioural Sciences and LearningLinköping UniversityLinköpingSweden

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