Behavioral Treatment for Hypertension
Reference
Schneider, R.H., Alexander, C.N., and Wallace R.K. In search of an optimal behavioral treatment for hypertension: A review and focus on Transcendental Meditation. In E.H. Johnson, W.D. Gentry, S. Julius (Eds.), Personality, Elevated Blood Pressure, and Essential Hypertension, Washington: Hemisphere, pp. 291-318, 1992.
Summary
This review discusses the needs and state-of-art in behavioral stress-reduction treatments for hypertension. Several key methodological weaknesses in the literature that have contributed to the modest results typically seen in the field have been delineated. In response to the continuing search for an effective behavioral program that has been rigorously documented to produce consistent results, we provide a historical review of the extant literature on the TM technique, blood pressure, and quality of life. Our review suggests TM as a candidate optimal treatment (and preventive) program for hypertension. This is because many of the studies on the TM technique found a) rapid onset of clinically significant blood pressure reductions; b) distinctive effectiveness compared with other traditional and modern relaxation techniques; c) relatively high compliance; d) documented acceptability and efficacy in a wide range of demographical groups (e.g., young, old, minority, and majority samples); e) efficacy as a sole or adjunctive treatment to medications; and f) generalization to the real-life environment outside of the clinic. Two studies used highly rigorous designs and methods in their exploration of various behavioral modalities, including the TM technique, and appear to satisfy most, if not all, of the methodological weaknesses apparent in previous research on stress-reduction treatments for hypertension. Another major value of the TM program suggested by a comprehensive review of the literature is a broad range of positive side benefits as opposed to adverse side effects in the major arenas of quality of life: physical health, psychological health, and social and cognitive functioning. Beneficial effects of the TM program have been observed on other behaviors that can effect risk for cardiovascular disease. The behaviors include reduced smoking, alcohol abuse, and enhanced self-efficacy (self-actualization). These latter behaviors may be recalcitrant to change in themselves but seem to respond spontaneously to a single intervention. Reduced cardiovascular morbidity and mortality from all causes have been noted in TM practitioners. Because of the wide range of integrated effects on the "mind-body" system, the TM technique could be considered a truly holistic psychophysiological intervention. Potential mechanisms of action of the TM technique have only begun to be elucidated, but some plausible psychological and mediators have already been identified. It may be suggested that a central mechanism of action to the TM technique is reduction of chronic psychological stress associated with enhanced neurophysiological homeostasis and orderliness. Prevention of cardiovascular dysregulation may be a natural consequence of enhanced central nervous system homeostasis.Thus, this research review indicates that the long-term consequences of TM practice may not only be reduced blood pressure, but also holistic prevention of stress-related diseases and promotion of more ideal health generally.
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