A standardized behavioral stepped care (SC) treatment for hypertension (blood pressure monitoring followed by self-administered systolic blood pressure biofeedback and relaxation, in sequence, as needed) was administered to 51 patients whose blood pressures were medically controlled to within normal limits. The effects of treatment upon blood pressure, medication requirements, and cost of care were compared with those of 51 referred care (RC) control patients who continued their usual care for hypertension. SC and RC patients were matched in groups on the basis of medication requirements (Group I, diuretics; Group II, beta-blockers alone or with a diuretic; and Group III, vasodilators alone or with a drug from Group I or II). The duration of the SC procedure was 1, 4, or 7 months--as necessary--and the follow-up period was 12 months. The RC protocol lasted 19 months. Medication requirements for SC patients declined to levels significantly (p less than 0.05) lower than those of RC patients from the biofeedback phase throughout follow-up for all drug groups combined. However, when the drug groups were analyzed separately, this was true for Groups I and II only. Similarly, the cost of care for all drug groups combined was lower for SC patients from the biofeedback phase through 9 months of follow-up, also reflecting changes seen in Drug Groups I and II only. Blood pressure levels remained controlled, in all groups, throughout the investigation. Clinical possibilities for combined behavioral and pharmacological treatment of hypertension are discussed relative to the pathophysiology of hypertension, and questions for future research are suggested.
Neurally mediated physiologic responses fulfill all of the criteria for behavior and obey all of the laws of behavior subject to the anatomic and physiologic constraints inherent in their structures and functions. It is illogical and wrong to assert that neurally mediated responses interact with behavior. THEY ARE BEHAVIOR. These principles are a legitimate and necessary part of the training of all medical students, residents, and fellows. The conceptual basis of psychosomatic practice does not need to be derived from the dualistic notions of psychoanalysis or from the dualistic notions of biobehaviorism. Psychosomatic medicine is an integral aspect of medical practice. It needs to exist because people act and react differently from one another, and because the same person acts and reacts differently from one situation to another. Psychosomatic medicine is not psychiatry in medicine. Each of the specialties and each of the subspecialties encounters its own set of psychosomatic problems; and treatment strategies to resolve these problems need to be integrated into the clinical practice of that discipline.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.