Transcript The Effect of Biofeedback Relaxation on Blood Pressure and Skin

The Effect of Biofeedback
Relaxation on Blood Pressure and
Skin Surface Temperature in
Hurricane Survivors
Kyungeh An, PhD, RN, Nancy Jallo, PhD, FNP-BC,
WHNP-BC, Victoria Menzies, PhD, RN
Virginia Commonwealth University
Background
(Photo by NASA 2008)
• Hurricane Ike hit Galveston and south east Texas in 2008
• Heavy landfall & storm surge followed by flooding
• Caused an extensive damage in this community.
Background
• More than 140,000 people in the Texas Gulf
Coast area had failed to evacuate
• Over 940 were rescued from rising waters
• Nearly 2,000 rescued afterward
Survivors of the Hurricane
Photos taken by An, 2008
• Witnessed demolishing of their homes and
neighborhood,
• Cleaning debris and recovering homes with a
huge demand & limited resources
• Faced loss of their loved ones
• Massive & prolonged unemployment
Aftermath Stress
Previous Studies
• After hurricane Katrina, incidence of coronary
heart disease (CHD) was increased by three fold
at two years and three years after Hurricane
(Gautam, 2009; Giao, 2012).
• Six months after Hurricane Ike, a survey with 401
respondents reported that over 60% (n=242) had
elevated stress levels, of 393 that completed
depression assessments, 34.6% (n=137) showed
elevated levels of depression (Bishop et al.,
2010).
Significance
• Survivors from hurricane often suffer long
lasting symptoms associated with stress such
as apprehension, elevated blood pressure, and
poor peripheral circulation.
• Biofeedback relaxation may alleviate these
symptoms associated with hyper arousal of
sympathetic nervous system, yet, there is
scanty of data that support scientific evidence
of the effectiveness of this technique.
Specific Aims
The objective of the study was to examine the effects of
biofeedback relaxation for 4 weeks on the psychological
and hemodynamic variables among hurricane survivors.
Specific aims of the study were to:
(1) examine whether there is a significant difference in
perceived stress, depression and anxiety score before
and after the 4 weeks of biofeedback relaxation
training;
(2) examine whether there is a significant changes in SBP,
DBP, HR, and skin surface temperature before and
after 4 weeks of biofeedback relaxation training
Methods: Setting
• 16 Participants were individuals who had
remained in Galveston, Texas during Hurricane
Ike in 2008
• Those who visited the St. Vincent Free clinic in
Galveston island and appeared high level of
stress after the event.
• Level of stress was measured by the Perceived
Stress Scale (
)
• No previous history of hypertension or circulatory
disorder, any fever last two weeks.
Methods: training
• A certified nurse provided the 20 minute
biofeedback relaxation intervention twice a
week for 4 weeks, accounting for a total of 8
sessions. Physiologic measures were obtained
after a 20 minute rest period prior to and
immediately after each intervention session.
Daily 20 minute home practice was
encouraged.
Methods: measurements
• Blood pressure and heart rate were measured
by the continuous BP monitor
• Skin surface temperature were measured by
the galvanometer
• Analysis : Changes in systolic/diastolic blood
pressure and skin temperature in each session
as well as the changes over 4 weeks were
analyzed using repeated measure ANOVA.
Procedures
Characteristics of the Sample
Age
Under 40
40 or older
Sex
Men
Women
Marital
Single
status
Married
Separated
Ethnic
Hispanic
group
White
Black
Other
Have
No
Insurance/ Yes
Smoking
No
Yes
Count (%)
3 (18.8)
13(81.3)
1(6.3)
15(93.8)
11(73.3)
2(13.3)
2(13.3)
2(12.5)
5(31.3)
9(56.3)
0(.0)
8(61.5)
5(38.5)
2(12.5)
14(87.5)
Psychological Strains
Descriptive Statistics (N=16)
Min
Perceived
Stress1
Depression2
Anxiety3
PTSD4
Max
Mean (±SD)
17.00
38.00
23.67±5.04
2.00
2.00
5.00
28.00
22.00
35.00
11.99±7.39
9.12±6.00
19.06±8.38
Norm
Male 12.1± 5.9
Female 13.7 ±6.6
1.Cohen, S., Kamarck, T., and Mermelstein, R. (1983). A global measure of perceived stress. Journal of
Health and Social Behavior, 24, 386-396.
2. & 3. Brief form of Symptom check list SCL-90-R(Derogatis & Melisaratos, 1983)
4. Trauma Screening Questionnaire (TSQ)(Coffey, et al.,1998)
Severity of PTSD
Severity of Symptoms (%)
1 (6%)
1 (6%)
2 (13%)
Minimal
4 (25%)
Mild
Moderate
8 (50%)
Severe
Extreme
Changes in Blood Pressure
150.00
145.00
Pre Systolic BP
140.00
Post Systolic BP
135.00
130.00
125.00
120.00
115.00
110.00
105.00
1
2
3
4
5
6
7
8
Results
• Sixteen participants complete the study.
• Both systolic and diastolic blood pressure
significantly decreased over time (Fdf=7=4.562,
p<0.001 for SBP and F df=7= 5.362, p<0.001 for
DBP).
• Skin surface temperature significantly increased
over time (Fdf=7=6.002, p<0.001).
• The increment of the temperature elevated by
the biofeedback training consistently increased
over time, indicating training effects (p<0.001).
Conclusion
• Biofeedback relaxation is an effective
intervention for attenuating high blood
pressure that may develop during the stressful
life event such as Hurricane. Results also
demonstrated relaxation effects on peripheral
vasodilation as demonstrated by the skin
surface temperature elevation.