Angele McGrady

Effects of Psychological Stress on Male Reproduction: A Review

Many forms of stress, including psychological, can affect male fertility and reproduction. The autonomic nervous system and the adrenal hormones participate in the classic stress response while also affecting the reproductive system. Evidence exists that mild-to-severe emotional stress depresses testosterone and perhaps interferes with spermatogenesis in the human male. There are difficulties, however, in attributing individual cases of infertility to psychological factors without evidence of psychopathology. In animals social stress, high altitude, surgery, and immobilization stress affect body weight, testosterone levels, and copulatory behavior with variable effects on testicular morphology. Stress applied to the pregnant rat also affects the development and sexual behavior of the male offspring. This literature is reviewed and discussed in terms of the usefulness of animal models and suggested future research.

Effects of depression and anxiety on adherence to cardiac rehabilitation.

PURPOSE To determine the effects of depression and anxiety on patient completion of structured cardiac rehabilitation. METHODS Retrospective chart review of 380 patients with myocardial infarction, coronary artery bypass graft, angina, or chronic heart failure referred to cardiac rehabilitation. Patient physical capacity was tested by the standard 12-minute walk test (WT). Depression, anxiety, and quality of life were assessed by standard questionnaires. Program completers were contrasted to dropouts on dependent variables at baseline. Baseline and postprogram WT, depression, anxiety, and quality of life were also compared in completers by using ANOVA and paired t tests. RESULTS One-half of entering patients completed the program. Statistically significant differences were observed in baseline depression, anxiety, and quality of life between program completers and dropouts. Dropouts had higher depression and anxiety scores and lower quality of life, but there were no differences in WT. Younger, female patients had higher dropout rates. Women also had higher psychological distress, lower quality of life, and less feet walked than men. Dropout rate was lowest in patients with coronary artery bypass graft and highest in patients with chronic heart failure. Both male and female completers evidenced significant improvements in WT, depression, anxiety, and quality of life. CONCLUSIONS Psychological distress makes completion of cardiac rehabilitation difficult. Patients need to be assessed early in the intervention so that depression and anxiety can be identified and managed. Completion of the program is advantageous because it is associated with improvement in all measured variables.

The effect of biofeedback-assisted relaxation training on blood pressure and selected biochemical parameters in patients with essential hypertension.

The effect of EMG biofeedback-assisted relaxation on blood pressure and selected biochemical parameters was evaluated in 38 patients with essential hypertension. Training consisted of 8 weeks of biofeedback and home practice of relaxation exercises. Mean blood pressure decreased in the experimental group from 144/90 to 133/84 mm Hg while the control group remained unchanged. Statistically significant decreases in the experimental group also occurred in muscle tension levels, in plasma aldosterone, and in urinary cortisol. Both aldosterone and cortisol are secreted by the adrenal cortex. It was concluded that the technique taught to the experimental group produced a reduction in skeletal muscle tension and a decrease in stress responding mediated by the adrenal cortex.

Effects of group relaxation training and thermal biofeedback on blood pressure and related physiological and psychological variables in essential hypertension

One hundred and one patients, 70 experimental and 31 controls, with a diagnosis of essential hypertension, were examined for the effects of group relaxation training and thermal biofeedback on blood pressure and on other psychophysiologic measures: heart rate, forehead muscle tension, finger temperature, depression, anxiety, plasma aldosterone, plasma renin activity, and plasma and urinary cortisol. Eighty percent of the participants were medicated. Treatment yielded a short-term success rate, defined as a decrease in mean arterial pressure of 5 mm Hg, of 49% in the experimental group. Other significant short-term changes included a reduction of forehead muscle tension, state anxiety, plasma aldosterone, and increased finger temperature. Follow-up measurements were made approximately 10 months after treatment in 36 patients, 51% of the treatment completers. Twenty of the 36 were short-term treatment failures, while 16 were treatment succeeders. Thirty-seven percent of the short-term succeeders continued to meet blood pressure criterion at follow-up. In short-term succeeders, continued practice of relaxation may influence long-term maintenance of decreased blood pressure. It is suggested that group relaxation training can be beneficial for short-term and long-term adjunctive treatment of essential hypertension in selected individuals.

The effects of biofeedback-assisted relaxation on cell-mediated immunity, cortisol, and white blood cell count in healthy adult subjects

The effect of biofeedback-assisted relaxation on cell-mediated immunity, cortisol, and white blood cell count was investigated in healthy adults under low-stress conditions. Fourteen subjects were trained with biofeedback-assisted relaxation for 4 weeks, while 17 subjects were controls. The group trained in relaxation techniques showed increased blastogenesis, decreased white blood cell count, due to decreased neutrophils, and no change in cortisol in comparison to the control group. Subjects with lower initial anxiety scores and forehead muscle tension levels showed larger increases in blastogenesis and larger decreases in neutrophils than subjects with higher initial anxiety and muscle tension levels.

Effect of biofeedback-assisted relaxation on blood pressure and cortisol levels in normotensives and hypertensives

This report examines the relationship between blood pressure and cortisol in normotensives and hypertensives. Both groups received biofeedback-assisted relaxation training. Both groups significantly decreased their muscle tension levels from baseline. Only the hypertensives decreased their blood pressure and cortisol levels after training. Implications for the role of cortisol in the relaxation response and in hypertension are discussed.

AUTOGENIC FEEDBACK TRAINING IN MIGRAINE: A TREATMENT REPORT

SYNOPSIS

Controlled Study of Biofeedback-Assisted Relaxation in Type I Diabetes

Objective The effect of biofeedback-assisted relaxation was tested in a randomized trial in 18 adults with insulin-dependent (type I) diabetes. Research Design And Methods Pretreatment and posttreatment blood glucose values and insulin dosages in the group trained for 10 wk in biofeedback-assisted relaxation were compared with those in the untrained group. Results Significantly lower average blood glucose levels, percentage of fasting blood glucose levels at target, and percentage of glucose values < 11.2 mM were observed in the trained group at posttest compared with the untrained group. Conclusions These differences could not be explained by increases in insulin. It is suggested that stress management be considered as an adjunct to the medical management of people with type I diabetes.

Role of mood in outcome of biofeedback assisted relaxation therapy in insulin dependent diabetes mellitus.

Stressful life events and negative mood have been associated with elevated blood glucose and poor self-care in individuals with diabetes. The purpose of this controlled study was to determine the effect of mood state, specifically depression, anxiety, and daily hassles on the outcome of biofeedback assisted relaxation in insulin dependent diabetes mellitus. Eighteen subjects completed the study, nine in biofeedback assisted relaxation and nine in the control group. There were no significant group differences in blood glucose between those receiving biofeedback assisted relaxation and the subjects continuing usual care. Five of the nine experimental subjects and one of the nine control subjects were identified as succeeders according to an arbitrary criterion. Treatment failures were more depressed, more anxious, and took longer to complete the protocol than succeeders. Statistically significant correlations were found between high scores on inventories measuring depression, anxiety, and hassles intensity and higher blood glucose levels and smaller changes in blood glucose as a result of treatment. It is suggested that mood has an important impact on the response to biofeedback assisted relaxation. Further research is necessary to determine whether assessment of anxiety and depression followed by appropriate treatment where necessary should precede biofeedback assisted relaxation in insulin dependent diabetes.

Psychological and Physiological Factors Associated with Tilt Table Testing for Neurally Mediated Syncopal Syndromes

MCGRADY, A., et al.: Psychological and Physiological Factors Associated with Tilt Table Testing for Neurally Mediated Syncopal Syndromes. This study investigated psychological and physiological factors in two groups of patients who had tilt table testing for autonomic dysfunction. The first group of 61 patients completed assessments of depression, anxiety, and symptom effects on lifestyle. The 25 patients identified as tilt positive were younger (30.5 years) and had higher mean depression scores (7.6) compared to the tilt‐negative response group (n = 36); the latter averaged 40 years of age and had mean depression scores of 4.6. These differences were statistically significant. Women testing tilt positive were significantly more depressed than tilt‐negative women (P = 0.02). More severe depressive symptoms were associated with lower blood pressure (BP) (P < 0.05). A second group of 52 patients was monitored during tilt for BP, heart rate (HR), skin temperature (TEMP), skin conductance level (SCL), and forehead muscle tension (EMG). Twenty‐seven tested positive and 23 were negative. There were statistically significant group differences in systolic BP and diastolic BP (P < 0.05). There was a significant interaction between tilt status (positive or negative) and time (P = 0.03) in HR. TEMP increased 2 degrees over time in both groups (P < 0.05). The decrease in SCL from 13.7 to 10.4 μΩ in the tilt‐positive response group compared to the slight increase in the tilt‐negative group was significantly different (P < 0.05). Identification of psychological factors correlated with BP and physiological changes that accompany decreases in BP in tilt‐positive response patients could guide management of patients with autonomic dysfunction.