Group therapy for asthma patients: a concept for the psychosomatic treatment of patients in a medical clinic--a controlled study. Relaxation therapy in bronchial asthma. The effects of a cognitive behavioural intervention in asthmatic patients. Evaluating the feasibility and efficacy of a self-administered manual-based stress management intervention for individuals with asthma: results from a controlled study. Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial. Evaluation of an individualised asthma programme directed at behavioural change. Cognitive-behavioral treatment combined with asthma education for adults with asthma and coexisting panic disorder. A pilot study of mind-body changes in adults with asthma who practice mental imagery. Biofeedback treatment for asthma. Effects of imagery, critical thinking, and asthma education on symptoms and mood state in adult asthma patients: a pilot study. Relaxation and music therapies for asthma among patients prestabilized on asthma medication. Respiratory sinus arrhythmia versus neck/trapezius EMG and incentive inspirometry biofeedback for asthma: a pilot study. Improvement of respiratory function in chronic asthmatic patients with autogenic therapy.
Asthma patients pose special problems as far as the medical supervision, danger of symptoms and the course of the disease are concerned. Some 90 asthma patients were registered for the treatment in the Heidelberg Medical Clinic. 31 patients who were interested in taking part were randomized into 3 groups: two treatment group consisted of the exchange of information, discussion sessions on the illness as well as 'autogenic training' or 'functional relaxation'. The third group was the control group. Before and after treatment the patients were submitted to a thorough examination both of lungs and other internal organs as well as from the psychodiagnostical point of view. The average age of the patients was 43.5 years and the average duration of illness 16.8 years. Nevertheless, the treatment group's sympathomimetics use was significantly reduced by 1 year of treatment (p less than 0.05); the use of steroids decreased as well. The number of visits of the general practitioner also decreased. These results support the conclusion that psychosomatic group therapy can make an important contribution to the treatment of asthma patients. Body therapy practised in 'autogenic training' and 'functional relaxation' seems to be another important healing factor for the treatment in addition to the discussion sessions and the exchange of information. nan There is evidence that educational programmes may improve patient's compliance with asthma treatment and control symptoms. Whilst medical parameters have been thoroughly studied, few data are available concerning psychological intervention. The aim of our open pilot study was to verify whether any difference in perceived illness and response style to asthma existed in the patients enrolled in an Asthma Rehabilitation Group (ARG) and in a Control Group (CG). Forty consecutive asthmatics were randomly enrolled, all of whom were diagnosed, treated and followed-up according to the International Guidelines. Both groups underwent a psychological assessment at baseline and after one year. A battery of questionnaires was used to obtain data relating to baseline characteristics (anxiety, depression, psychophysiological disorders), emotional reactions to asthma attacks (panic-fear, etc,) and cognitive variables (external control, psychological stigma, internal beliefs, external chance, etc.) involved in the perceived illness. In addition, the Asthma Rehabilitation Group patients underwent an educational programme and a cognitive-behavioural intervention. In both groups, a reduction of anxiety and depression scores was observed, as well as a significant improvement of the medical parameters evaluated. Only the Asthma Rehabilitation Group reported lower scores on the Psychophysiological Questionnaire and on the External Control Subscale after 1 year. The Control Group reported higher score on the External Chance Scale. The data of our study seem to confirm the effectiveness of psychological intervention on the cognitive skills involved in the perception and management of asthma. Larger scale studies on this topic are suggested. Several behavioral medicine interventions (e.g., relaxation training and written emotional expression) have been proposed as effective supplemental treatments for individuals with chronic illnesses such as asthma. Whether these treatments are feasible or effective in a manual-based, self-administered format is unclear, and few studies have examined the effectiveness of such treatments presented in a complementary format. We examined the feasibility and effectiveness of a 4-week stress management treatment compared with a matched placebo intervention in young adults with asthma. Both groups considered the workbooks credible treatment interventions and completed them conscientiously. The treatment group showed significant improvement in measures of lung function compared with the placebo group, but analysis revealed no differences in measures of perceived stress. These findings provide initial support for the feasibility of self-administered manual-based interventions and some evidence that they can produce health benefits in individuals with asthma and, perhaps, other chronic conditions. A prospective, randomised, single blind, and controlled trial of a hypnotic technique was undertaken in 39 adults with mild to moderate asthma graded for low and high susceptibility to hypnosis. After a six week course of hypnotherapy 12 patients with a high susceptibility score showed a 74.9% improvement (p less than 0.01) in the degree of bronchial hyper-responsiveness to a standardised methacholine challenge test. Daily home recordings of symptoms improved by 41% (p less than 0.01), peak expiratory flow rates improved by 5.5% (p less than 0.01), and use of bronchodilators decreased by 26.2% (p less than 0.05). The improvement in bronchial hyper-reactivity occurred without a change in subjective appreciation of the degree of bronchoconstriction. A control group 17 patients and 10 patients undergoing treatment with low susceptibility to hypnosis had no change in either bronchial hyper-responsiveness or any of the symptoms recorded at home. This study shows the efficacy of a hypnotic technique in adult asthmatics who are moderately to highly susceptible to hypnosis. An individualised asthma programme directed at behavioural change was evaluated in asthmatic subjects who reported complaints and impairment, despite adequate medical treatment. Mild-to-moderate asthma patients (n=23) were randomly assigned to a programme or waiting list condition. Outcome measures were: McMaster Asthma Quality of Life Questionnaire, Asthma Symptom Checklist, Negative Emotionality Scale, Knowledge, Attitude and Self-Efficacy Asthma Questionnaire, Adherence Scale, and peak flow measurements. Both groups were evaluated at three consecutive moments, each separated by 3 months; the programme was delivered between the first two evaluations. At onset the patient received a workbook containing information, exercises and homework assignments. Psycho-education, behavioural and cognitive techniques were introduced during six 1-h individual sessions. Compared with controls the programme group reported less symptoms (obstruction, fatigue), better quality of life (activity, symptoms, emotions), decreased negative affectivity, and increased adherence, immediately after finishing the programme and at 3 months follow-up. All three cognitive variables (knowledge, attitude towards asthma, self-efficacy) and day and night peak flow ratings improved in the programme group but not in the waiting list group. Participation in an individualised programme resulted in improvement of asthma morbidity, and asthma-related behaviour and cognitions, in subjects reporting symptoms and impairment despite adequate medical therapy. This study tested the efficacy of a nurse-administered 8-week group treatment program for adults with asthma suffering from coexisting panic disorder. The program consisted of cognitive behavioral treatment (CBT) for panic disorder combined with asthma education (AE). Forty-eight women with a confirmed diagnosis of asthma and panic disorder were randomly allocated to a treatment condition (n=25) and a wait-list control condition (n=23). Twenty-five participants--15 in the treatment group and 10 in the wait-list control group--completed treatment. Repeated measures ANOVA procedures were used to compare the groups on panic and asthma outcomes at posttreatment and 6-month follow-up. The results demonstrate that the CBT-AE program is capable of producing substantial and durable antipanic and antianxiety treatment effects and led to substantial but nonsustained improvement in morning peak-flow expiratory rate and asthma-related quality of life. Implications of these findings for this clinical population are addressed. Despite the growing number of studies of imagery and the use of complementary and alternative modalities as treatments for asthma, research on mental imagery in adults with asthma is practically, nonexistent. The purpose of this feasibility study was to lay groundwork for a larger follow-up clinical trial.
                To determine whether pulmonary function, asthma symptoms, quality of life, depression, anxiety, and power differ over time in adults with asthma who do and do not practice mental imagery (MI). (Power is the ability to make aware choices with the intention of freely involving oneself in creating desired change.)
                Randomized controlled study using univariate repeated measures analysis of variance (ANOVA) and replacement through block design.
                Lenox Hill Hospital, an affiliate of New York University Medical School, New York, NY.
                Sixty-eight adults with symptomatic asthma, after 4 weeks of baseline data collection and analysis, met requirements for this randomized controlled study. Thirty-three completed pulmonary function as well as self-report tests at 4 time points over 17 weeks. The 16 experimental participants also completed the 4-session imagery protocol.
                Individual imagery instruction (week 1) and follow-up (weeks 4, 9, 15). Participants were given 7 imagery exercises to select from and practice 3 times a day for a total of 15 minutes.
                1) Spirometry (FEV1); 2) medication use; 3) Asthma Quality of Life Questionnaire; 4) Beck Depression Inventory; 5) Spielberger Anxiety Scales (A-State and A-Trait); 6) Barrett Power as Knowing Participation in Change Tool, Version II; 7) Epstein Balloon Test of Ability to Image.
                There was little evidence of statistical change in this feasibility study; yet, valuable lessons were learned. Paired t-tests indicated there was a significant difference in the total power scores in the imagery group, and in the expected direction (two-tailed, t-statistic = -2.3, P = 0.035) and the choices sub-scale (two-tailed, tstatistic = -2.93, P = 0.01) of the power instrument from weeks one to 16 of the study. Eight of 17 (47%) participants in the MI group reduced or discontinued their medications. Three of 16 (19%) participants in the control group reduced their medications; none discontinued. Chi-square indicated differences between groups (X2 = 4.66, P = 0.05). Persons who reduced or discontinued their medications showed neither an increase in pulmonary function prior to medication discontinuation, nor a fall in these parameters following discontinuation.
                Findings related to major outcome measures must be viewed with caution due to the small sample size resulting from attrition related to labor intensiveness and, therefore, low statistical power. However, the study did provide significant data to plan a larger scale study of the use of mental imagery with adult asthmatics. The study also demonstrated that imagery is inexpensive, safe and, with training, can be used as an adjunct therapy by patients themselves. Its efficacy needs additional exploration. Further research for adults with asthma who practice imagery is important, as current treatments are not entirely efficacious. Lessons learned in this study may facilitate improvement in research designs. We evaluated the effectiveness of heart rate variability (HRV) biofeedback as a complementary treatment for asthma.
                Ninety-four adult outpatient paid volunteers with asthma.
                The psychophysiology laboratory at The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, and the private outpatient offices of participating asthma physicians.
                The interventions were as follows: (1) a full protocol (ie, HRV biofeedback and abdominal breathing through pursed lips and prolonged exhalation); (2) HRV biofeedback alone; (3) placebo EEG biofeedback; and (4) a waiting list control.
                Subjects were first prestabilized using controller medication and then were randomly assigned to experimental groups. Medication was titrated biweekly by blinded asthma specialists according to a protocol based on National Heart, Lung, and Blood Institute guidelines, according to symptoms, spirometry, and home peak flows.
                Subjects recorded daily asthma symptoms and twice-daily peak expiratory flows. Spirometry was performed before and after each weekly treatment session under the HRV and placebo biofeedback conditions, and at triweekly assessment sessions under the waiting list condition. Oscillation resistance was measured approximately triweekly.
                Compared with the two control groups, subjects in both of the two HRV biofeedback groups were prescribed less medication, with minimal differences between the two active treatments. Improvements averaged one full level of asthma severity. Measures from forced oscillation pneumography similarly showed improvement in pulmonary function. A placebo effect influenced an improvement in asthma symptoms, but not in pulmonary function. Groups did not differ in the occurrence of severe asthma flares.
                The results suggest that HRV biofeedback may prove to be a useful adjunct to asthma treatment and may help to reduce dependence on steroid medications. Further evaluation of this method is warranted. To compare biologically targeted imagery (BTI) and critical thinking asthma management (CTAM) outcomes.
                Participants were randomized to BTI (group 1, G1) or CTAM (group 2, G2) in a 2 x 2 x 4 design (BTI/CTAM x pretest/post-test x weeks [3 week averaged intervals of symptoms and peak flows]). Interventions were asthma education plus treatment (BTI or CTAM for two 2-hour sessions per week for 6 weeks). For BTI, data collection (symptoms, lung function) occurred preintervention (3 week baseline), during the intervention (6 weeks), and postintervention (6 weeks). For CTAM, data collection occurred at wait-list control (WLC) (12 weeks extended baseline), preintervention (3 weeks), during the intervention (6 weeks), and postintervention (6 weeks).
                Alaska Regional Hospital, Anchorage.
                Seventy (70) adults (53 women, 17 men) with asthma.
                WLC record keeping, BTI, or CTAM. Outcome measures: Dependent variables included asthma symptoms (wheezing, coughing, sleep, activity, attacks, peak flow) and self-report assessments of Profiles of Mood States (POMS-BI) (anxiety, hostility, depression, uncertainty, fatigue, confusion); Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire (KASE-AQ); Health Attribution Test (HAT) for locus of control (LoC); and the Revised Asthma Problem Behavior Checklist (RAPBC).
                Analyses of covariance with repeated measures contrasted BTI pre- to post-tests, time periods, and WLC; CTAM pre- to post-tests, time periods, and extended baseline WLC; and BTI to CTAM outcomes. WLC improved all POMS-BI scores except anxiety, increased internal LoC, and reduced problematic behaviors. Compared to WLC, BTI reduced wheezing, anxiety, and chance LoC, and increased asthma knowledge, attitude, and self-efficacy. Compared to CTAM, BTI reduced wheezing and chance LoC, increased internal LoC, and improved 6 POMS-BI scores. Compared to extended baseline WLC, CTAM increased asthma knowledge, attitude, self-efficacy, internal LoC, and peak flow.
                Both interventions significantly improved symptoms and asthma management more than record keeping. Contrary to hypothesis, BTI produced better outcomes than CTAM. One hundred six asthmatic subjects were medically prestabilized, then assigned to eight sessions of progressive relaxation, music, or a waiting-list. Seventy-two subjects completed treatment, of which 37 were evaluated in the laboratory with measures of forced expiratory flow. Relaxation-group subjects reported feeling the most deeply relaxed and produced the greatest improvement in forced expiratory flow during the last presession assessment period. All groups evidenced decreases in asthma symptoms. All groups showed decreases in pulmonary function immediately after relaxation sessions. None of the changes in pulmonary function reached levels that are accepted in drug trials to be of clinical significance, and the therapeutic changes occurred only in the situation where training was rendered. Listening to music produced greater decreases in peaks of tension than progressive relaxation, and it produced greater compliance with relaxation practice, but it did not produce any specific therapeutic effects on asthma. This pilot study compared biofeedback to increase respiratory sinus arrhythmia (RSA) with EMG and incentive inspirometry biofeedback in asthmatic adults. A three-group design (Waiting List Control n = 5, RSA biofeedback n = 6, and EMG biofeedback n = 6) was used. Six sessions of training were given in each of the biofeedback groups. In each of three testing sessions, five min. of respiratory resistance and EKG were obtained before and after a 20-min biofeedback session. Additional five-min epochs of data were collected at the beginning and end of the biofeedback period (or, in the control group, self-relaxation). Decreases in respiratory impedance occurred only in the RSA biofeedback group. Traub-Hering-Mayer (THM) waves (.03-.12 Hz) in heart period increased significantly in amplitude during RSA biofeedback. Subjects did not report significantly more relaxation during EMG or RSA biofeedback than during the control condition. However, decreases in pulmonary impedance, across groups, were associated with increases in relaxation. The results are consistent with Vaschillo's theory that RSA biofeedback exercises homeostatic autonomic reflex mechanisms through increasing the amplitude of cardiac oscillations. However, deep breathing during RSA biofeedback is a possible alternate explanation. Stress, unpleasant emotions and autonomic imbalance may play a main role in precipitating asthmatic attacks. In this study two homogeneous groups of asthmatic patients (N = 24) are treated over an eight-month period. The experimental group was treated with autogenic therapy and the control group with supportive group psychotherapy. Respiratory function parameters measured were Forced Vital Capacity (FVC), Forced Expiratory Volume in the first sec (FEV1), Forced Expiratory Flow between 25% and 75% of the FVC (FEF25-75%), and Mesoexpiratory Flow (MEF50%). The group under Autogenic Therapy obtained a relevant clinical improvement (> 15% of pretreatment values) in respiratory function. No significant changes were observed in the control group. These results suggest that autogenic therapy could be an effective adjunctive treatment in bronchial asthma.