Behavioral medicine approaches to hypertension: An integrative analysis of theory and research

Abstract

This article compares behavioral and biological approaches to hypertension, highlights some of the practical, semantic, and theoretical issues involved, and attempts a constructive, behavioral medicine integration of these approaches. The major behavioral approaches to hypertension are described, with a focus on their conceptual limitations as stimulants to research into psychobiological mechanisms. A biobehavioral systems analysis of hypertension is outlined, emphasizing the role of the central nervous system as a common pathway relating environmental and behavioral factors to cardiovascular regulatory dynamics and disease. Schwartz's concept of blood pressure disregulation is discussed, by which behavioral "feedback loops" may be included in the pathogenesis of homeostatic disorders. A detailed discussion of concepts underlying the clinical pharmacological approach to hypertension is provided; parallels are drawn between the conceptual framework and the theoretical and practical questions facing behavioral researchers concerned with hypertension. Synergistic interactive effects of drug and behavioral treatments are proposed. A biobehavioral overview, which links pressor and depressor stimulus patterns to both pathogenesis and therapy, can serve to integrate the previous biobehavioral systems analysis, the conceptual framework of clinical pharmacology, and the notion of biobehavioral disregulation of blood pressure. Implications for future behavioral medicine research in hypertension are provided.

Life Stress, Health, and Blood Pressure in Black College Students

“…As several investigators have recently suggested, a more productive approach to the study of psychosocial factors and diseases such as hypertension is to use a multidimensional approach in which known risk factors such as family history of the disease, cardiophysiologic characteristics, diet, and life style are included in the design along with the more elusive psychosocial variables (Lazarus, 1978;Stahl, Grim, Donald, & Niekirk, 1975). Harrell (1980) and Schwartz, Shapiro, Redmond, Ferguson, Ragland, and Weiss (1979) go a step further and recommend that experimental stresses be used rather than self-reports of phenomenal life stresses. Regardles of the type of stressors studied, it is important that studies of the contribution of stress in disease take into account the interplay of the following four factors: (a) individual, ethnic, and social class differences in appraisal and responses to stress (Askenasy, Dohrenwend, B. P., Dohrenwend, B. D., 1977;Goldstein, 1973); (b) interpersonal interaction factors such as personal stress-coping styles (Lazarus, 1974;Diamond, 1982), and the availability and use of social supports (Cobb, 1976;Dean & Lin, 1977;Billings & Moos, 1981); (c) physical-environmental variables such as socioecologic stress levels in the living environment (Harburg, Erfurt, Hauenstein, Chape, Schull, & Schork, 1973;Kosa, Antonovsky, & Zola, 1969); and, (d) larger societal and sociopsychological variables, such as the status-related effects of ethnicity and social class on stress exposure and stress-related health risks (Dohrenwend, B. P., & Dohrenwend, B. S., 1970;Myers, 1982).…”

Dynamic Processes in Regulation and Some Implications for Biofeedback and Biobehavioral Interventions

“…Without the ready availability of mathematical models for the social and biological sciences, a nonmathematical approach to systems theory was prominent in early biofeedback work, and was well articulated by Schwartz and colleagues (Schwartz, 1981; Schwartz et al, 1979). However, a mathematical approach for aircraft communication and control systems had been articulated by Wiener as early as the 1940s (Wiener, 1948, 1961).…”

Hypnosis and Relaxation in the Medically Ill

“…Their work follows that of Selye [39] and Cannon [40] who found a deleterious effect on the cardiovascular function and other organ systems from chronic stress. Most reviewers in this area conclude that pharma cotherapy is superior to psychological tech niques in the management of hypertension [41,42], However, several studies [43][44][45] have found that relaxation strategies coupled with exercise training or a cognitive therapy can diminish cardiac events, hospital readmissions and recurrent myocardial infarction in patients who have had a heart attack. Per haps because of the great popularity and suc cess of the work of those who considered relaxation and TABP as the most important psychological variables in heart disease, there are not many publications in this area utiliz ing hypnosis.…”