Thomas H. Fine

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.

The effect of brief restricted environmental stimulation therapy in the treatment of essential hypertension

Abstract This pilot project investigated the effects of controlled frequent brief REST relaxation sessions on the blood pressure of three subjects with borderline essential hypertension. A flotation REST system was used, and subjects had 2 or 3 sessions weekly for 2 months. All three subjects had blood-pressure reductions of a clinically significant magnitude across the treatment and follow-up periods.

Effects of relaxation associated with brief restricted environmental stimulation therapy (REST) on plasma cortisol, ACTH, and LH

Restricted Environmental Stimulation Therapy (REST), which involves placing an individual into an environment of severely reduced stimulation for brief periods, has been subjectively reported to produce deep relaxation. The present study determines the effects of REST-assisted relaxation on plasma cortisol, ACTH, and luteinizing hormone (LH). These parameters were also measured in a group exposed to a similar relaxation paradigm, but without REST (non-REST). Each subject experienced two baseline sessions (1 and 2), four REST (or non-REST) relaxation sessions (3, 4, 5, 6), and two follow-up sessions (7 and 8). Pre- and postsession plasma hormone levels were measured in sessions 1, 2, 5, and 8. Both REST and non-REST subjects reported that the experience was relaxing. During the treatment period (session 5) pre- to postsession changes in cortisol and ACTH, but not in LH, were significantly greater for the REST group than for the non-REST group. Plasma cortisol level also decreased across sessions in the REST group, with levels in sessions 5 and 8 significantly lower than the baseline (sessions 1 and 2). Non-Rest subjects showed no change in plasma cortisol across sessions. No significant change in plasma ACTH or LH occurred across sessions in the REST or non-REST groups, although ACTH showed a decreasing trend. These data demonstrate that repeated brief REST-assisted relaxation produces a relaxation state associated with specific decreases in pituitary-adrenal axis activity.

The presence or absence of light during flotation restricted environmental stimulation: Effects on plasma cortisol, blood pressure, and mood

This study examined the effect of light on relaxation associated with flotation restricted environmental stimulation therapy (REST), as measured by plasma cortisol, mean arterial pressure, and psychometric parameters. Twenty-one subjects were paired by baseline cortisol levels into two groups: one experiencing flotation REST in the presence of light (REST-L) and one experiencing flotation REST in the absence of light (REST-D). Subjects were 15 male and 6 female students aged 22–28 in normal health who had not experienced REST. Repeated flotation REST (8 sessions) either with light or without light was associated with a decrease in plasma cortisol and a decrease in mean arterial pressure, with no differences in effectiveness between groups. The psychometric assessment of mood, using the POMS scale, before and after sessions 1 and 8 revealed mood state improvement in both REST-L and REST-D groups. These data suggest that the presence of light did not compromise the flotation REST experience, as evidenced by the lack of difference between REST-L and REST-D groups.

Effects of Biobehaviorally Assisted Relaxation Training on Blood Pressure and Hormone Levels and Their Variation in Normotensives and Essential Hypertensives

This paper reports on the effect of two relaxation-based treatment modalities, biofeedback-assisted (BF) relaxation and restricted environmental stimulation therapy (REST) on the absolute levels and the variation of blood pressure, Cortisol, aldosterone and plasma renin activity in 18 hypertensives and 13 normotensives. Sixty-seven percent of both hypertensive groups achieved clinically significant blood pressure reductions across treatment. Decreases were also observed in the average levels of each hormone in all subgroups except normotensive BF. In some individuals the blood pressure changes were not associated with changes in hormone levels. Variation, reported as standard deviation, decreased across treatment for blood pressure, Cortisol and aldosterone in both hypertensive and normotensive REST subgroups. The BF subgroups showed no consistent changes. These results are discussed in the context of adrenocortical activity, volume regulation of blood pressure and cybernetic theory.

Hormonal Changes Associated with Restricted Environmental Stimulation Therapy

Restricted Environmental Stimulation Therapy (REST), which involves placing an individual into an environment of severely reduced stimulation for brief periods, has been subjectively reported to produce deep relaxation. The present studies determine the effects of REST-assisted relaxation in the plasma levels of several hormones including Cortisol, ACTH, luteinizing hormone (LH) and testosterone and urinary levels of Cortisol. The possible role of endogenous opioids in the mild euphoria which is frequently associated with REST-assisted relaxation was also examined in a preliminary study using an opiate antagonist, naloxone. Varied protocols in these studies with different groups of subjects included from 4 to 20 REST sessions in frequencies ranging from bi-weekly to daily. The direct hormone measurement studies utilized a baseline-treatment-follow-up design, whereas the naloxone study employed a single subject double-blind crossover design. Plasma and urinary Cortisol and plasma ACTH showed significant decreases associated with REST. Testosterone and HL levels in plasma did not change. All subjects reported that the REST experience was deeply relaxing. Naloxone treatment consistently prevented the mild euphoria associated with REST. These data suggest that REST-assisted relaxation is associated with REST. These data suggest that REST-assisted relaxation is associated with specific decreases in the activity of the pituitary-adrenal axis, and that the mild euphoria occurring in REST may be mediated by release of altered sensitivity to endogenous opioids.

Differential Effects of Wet and Dry Flotation REST on EEG Frequency and Amplitude

During the last decade there have been numerous studies examining physiological processes altered during human exposure to brief flotation REST. These studies have examined heart rate (Turner & Fine, 1985a; Belinson & Forgays, 1985), muscle tension (Jacobs, Heilbronner, & Stanley, 1985; Fine & Turner, 1987), blood pressure (Fine & Turner, 1982; Jacobs, Heilbronner, & Stanley, 1985; McGrady et al, 1987; Turner et al., 1989) and various plasma and urinary endocrine measures (Turner & Fine, 1983, 1985, 1991; Turner et al., 1987; McGrady et al., 1987). Except for a study of EEG theta (Barabasz, 1990b), electrocortical activity in flotation REST has not been studied. Since it has been repeatedly demonstrated that brief flotation REST affects subjective experience and physiological processes it seems reasonable to postulate that it also may have somewhat specific effects on the electrical activity of the brain. Barabasz (1990b) found significantly increased theta after flotation REST.

Effects of Wet and Dry Flotation REST on Blood Pressure and Plasma Cortisol

Flotation Restricted Environmental Stimulation Therapy (F-REST) has been used successfully in the treatment of several stress-related disorders (Fine & Turner, 1982, 1985a; Rzewnicki et al., 1990; Koula et al, 1990). In F-REST (henceforth, REST) an individual lies supinely in thermoneutral buoyant fluid with minimal photic, auditory and tactile stimulation (Lilly, 1977). Deep relaxation reportedly accompanies REST (A. Barabasz, M. Barabasz, Dyer & Rather, 1990; Turner & Fine, 1983; Suedfeld, Ballard & Murphy, 1983). Relaxation has been shown to be associated with decreased activity of the adrenal axis (Davidson et al., 1979; Michaels, Huber & McCann, 1979; Jevning, Wilson & Davidson, 1978; McGrady et al., 1981). Plasma Cortisol can be measured as an indicator of this axis, and levels have been shown to decrease during REST (Turner & Fine 1983; McGrady et al., 1987). In addition, a decrease in blood pressure has been a common finding in previous REST studies (Jacobs, Heilbronner & Stanley, 1985; Fine & Turner, 1982; Kristeller, Schwartz & Black, 1982; Suedfeld, Roy & Landon, 1982), indicating that, along with plasma Cortisol, blood pressure can be a reliable index of the REST effect.

Effects of Flotation REST on Range of Motion, Grip Strength and Pain in Rheumatoid Arthritics

Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disease of unknown etiology. It is a leading cause of long term disability with approximately 60% of the patients becoming disabled within 10 years (Whisler & Rothsmich, 1985). This disease, which commonly shows onset in the 20–55 age range, involves a systemic inflammation of the synovial membranes of joints as well as joint capsules, tendons, and tendon sheaths (O’Sullivan, Cullen, & Schmitz, 1981). It appears that the synovial membrane undergoes a local autoimmune response causing increased vascular permeability and collection of cellular blood elements. The infiltration causes the synovial membrane to become thickened and multicellular. As the disease progresses, chronic synovitis develops and destruction of cartilage and subchondral bone occurs.

A Descriptive Analysis of Factors Leading to a 1-Year Remission in Bipolar Disorder.

Background: Bipolar spectrum disorders are associated with symptomatic and functional disability in many patients. Other studies have examined predictors of outcome with variable results. The goal of this retrospective study was to identify medications associated with a minimum of 12 consecutive months of symptomatic, functional, and syndromal remission. Methods: The charts of 121 patients with confirmed bipolar disorder were reviewed. Data on medical regimen and demographic and adherence factors were gathered using standardized data collection sheets approved by the University of Toledo Institutional Review Board. The criterion for improvement was set at 12 consecutive months of Clinical Global Impressions Improvement ratings of ⩽2, which is a far higher standard of syndromal and functional remissions than the usual 8 consecutive weeks used by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Results: In this sample of 121 patients, 43.8% achieved a minimum of 12 consecutive months of remission, whereas 56.2% did not. When bipolar disorder was divided into its subtypes, 45.5% of our cohort were diagnosed with bipolar I disorder, 27.3% were diagnosed with bipolar II disorder, and 27.3% were diagnosed with bipolar disorder, not otherwise specified. Of the 55 patients with bipolar I disorder, 27 remitted and 28 did not. Of the 33 patients with bipolar II disorder, 12 remitted and 21 did not. Of the 33 patients with bipolar disorder, not otherwise specified, 14 remitted and 19 did not. The treatment regimen that was most closely associated with remission was a combination of atypical antipsychotics (primarily aripiprazole), mood stabilizers (primarily lamotrigine), and an antidepressant. In addition, the patients who achieved remission were more likely to be adherent to medication and with appointments. Conclusions: The chart review showed that 12 consecutive months of symptomatic remission was achieved in our clinic in 43.8% of patients with bipolar disorder when they were treated with tailored medication regimens. The remainder (56.2%) failed to achieve 12 consecutive months of remission based on real-time Clinical Global Impressions Improvement ratings. The combination of an atypical antipsychotic, a mood stabilizer, and an antidepressant was highly correlated with 1-year remission.