تأثیر مداخلات هیجان محور و شناختی بر کاهش استرس بیماران CABG از طریق افزایش فرکانس رزونانسHRV

نوع مقاله: علمی- پژوهشی

نویسندگان

1 عضو هیئت علمی (مربی) پژوهشگاه مطالعات آموزش و پرورش

2 عضو علمی دانشگاه تهران/رئیس دانشکده

3 عضو علمی دانشکده روانشناسی / دانشگاه تهران

4 عضو علمی دانشگاه علوم پزشکی تهران -متخصص قلب و عروق/ مرکز قلب تهران

چکیده

هدف: هدف از این مطالعه بررسی تأثیر مداخلات هیجان­محور و شناختی برافزایش فرکانس رزونانس تغییرپذیری ضربان قلب (HRV) و کاهش استرس بیماران به دنبال جراحی عروق کرونر قلب بود.
روش:مطالعه حاضر از نوع کوشش‌های بالینی تصادفی (RCT) بود. تعداد 75 بیمار جراحی‌شده­ عروق کرونر قلب(CABG)از بین بیماران شرکت‌کننده در برنامۀ بازتوانی مرکز قلب تهران انتخاب شدند. این بیماران به‌صورت تصادفی در سه گروه 25 نفری مداخله­ای 1) مداخلات هیجان محور، 2) مداخلات مختلط (هیجان­محور و شناختی)، 3) گروه کنترل (مداخلات متعارف بیمارستانی) قرار گرفتند. هر سه گروه پیش از مداخلات از نظر استرس و فرکانس رزونانس با استفاده از خرده مقیاس استرس آزمون DASS-21 و دستگاه پایشHRV مورد ارزیابی قرار گرفتند.هر سه گروه به مدت 5 هفته تحت مداخلات روان‌شناختی متناسب با گروه بودند و پس از مداخلات دوباره به‌وسیله همان ابزار و مقیاس‌ها مورد ارزیابی مجدد قرار گرفتند.
یافته­ها: تحلیل کوواریانس نشان داد دو گروه مداخله­ای اصلی در مقایسه با گروه کنترل کاهش معناداری را در استرس نشان داده­اند. این کاهش هم از نظر آماری (05/0>P) و هم از نظر بالینی معنادار بود. گروه مداخله­ای مختلط در مقایسه با گروه مداخله­ای هیجان­محور کاهش معنادار بیشتری را نشان داد.نتایج حاصل از HRV بیماران نیز حاکی از این بود که گروه‌های مداخله­ای اصلی افزایش معناداری (01/0>P) در فرکانس رزونانس نشان داده­اند.
نتیجه­گیری:مداخلات روان‌شناختی می­توانند موجب کاهش هیجان‌های منفی و استرس و افزایش فرکانس رزونانس HRV  حول و حوش 1/0 هرتز و متعاقباً افزایش تغییرپذیری ضربان قلب(شاخص سلامتی و بهبود)در بیماران کرونری­ شوند.

کلیدواژه‌ها


عنوان مقاله [English]

The Effect of emotion-focused and cognitive interventions on reduction of stress in CABG patients by increasing HRV resonance frequency

نویسندگان [English]

  • behnam behrad 1
  • Hadi Bahrami Ehsan 2
  • Reza Rostami 3
  • Saeed Sadeghyan 4
چکیده [English]

Objective: we examined the effect of emotion-focused and cognitive interventions on resonance frequency (RF) of heart rate variability (HRV) and stress reduction in patients after coronary artery bypass graft surgery (CABG).
 
Methods: 75 post-CABG patients who were participated in cardiac rehabilitation program of Tehran Heat Center(THC) were selected based on inclusion criteria uch as age 
Results: The results showed significant reduction in stress (P 
Conclusion: psychological interventions such as emotion-focused and cognitive techniques can reduce stress and negative emotions in patients with coronary heart disease. The interventions can increase also resonance frequency (0.1Hz) and consequently heart rate variability (index of health and well-being) of stressed Coronary patients.

کلیدواژه‌ها [English]

  • Heart Rate Variability
  • Resonance Frequency
  • Stress Reduction
  • Psychological Interventions
  • Coronary Heart Disease

بشارت، م.ع. (1384). بررسی ویژگی‌های روان‌سنجی مقیاس افسردگی اضطراب استرس (DASS-21) در نمونه­های بالینی و جمعیت عمومی. گزارش پژوهشی، دانشگاه تهران.

 

صاحبی، ع.؛ اصغری، م.ج.؛ سالاری، ر.س. (1384). «اعتباریابی مقیاس افسردگی اضطراب تنیدگی (DASS-21) برای جمعیت ایرانی». فصلنامۀ روان­شناسان ایرانی، سال اول، شماره 4.

 

Abdulghader, A.A. (2012). “Coherence: a novel nonpharmacological modality for lowering blood pressure in hypertensive patients”. Global advances in health and medicine, 1(2), 54-62

Allen, B. & Friedman, B. (2012). “Positive emotion reduces dyspnea during slow paced breathing”. Psychophysiology, 49, 690-696.

 

37

Alvaro, B.; Tang, R. & Zhu Carolyn. (2011). “The effect of mental stress on heart rate variability”. NJ Governor’s School of Engineering & Technology Retrieved from http://oldsoe.rutgers. edu/files/2011HeartRate.pdf
Berntson, G.G. & Cacioppo, J.T. (2004). Heart rate variability: Stress and psychiatric conditions. In Malik, M. &Camm, A. J. (Eds), Dynamic Electrocardiography. Retrived from http://psychology. uchicago.edu/people/faculty/cacioppo/jtcreprints/bc04.pdf.

Borell, E.V.; Langbein, J.; Després, G.; Hansen, S.; Leterrier, C.; Marchant-Forde, J. & et al. (2007). “Heart rate variability as a measure of autonomic regulation of cardiac activity for assessing stress and welfare in farm animals-A review”. Physiology and Behavior. 92, 293-316.

Brotman, D.J. Golden, S.H. &Wittstein, I.S. (2007). “The cardiovascular toll of stress”. Lancet, 370, 1089-1100.

Brown, K.W. & Ryan, R.M. (2003). “The benefits of being present: mindfulness and its role in psychological well-being”. Journal of personality and social psychology. 84(4), 822-848

Chamberlin, D.E. (2011). “Physiological Psychotherapy: Opening the Trauma Window in High Achievers”. Biofeedback, 39 (1),21-26 DOI 10.5298/1081-5937-39.1.09.

Childre, D.; Martin, H. & Beech, D. (2000). The HeartMath solution. U.S: HarperCollins Publication.

Davidson, K.W. Mostofsky, E. & Whang, W. (2010). “Don’t worry, be happy: positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey”. European heart journal, 31, 1065-1070. doi:10.1093/eurheartj/ehp603

Del Pozo, J.M.; Gevirtz, R.N.; Scher, B. & et al. (2004). “Biofeedback treatment increases heart rate variability in patients with known coronary artery disease”. American Heart Journal, 147:E11.

Fang, J.; Shaw, K.M. & Keenan, N. L. (2011). Prevalence of Coronary heart disease. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention. Retrieved from http://www.cdc.gov /mmwr/preview/mmwrhtml/mm6040a1.htm.

Gaziano, T.A. Bitton, A. Anand, S. Gesel, S.A & Murphy, A. (2010). "Growing Epidemic of Coronary Heart Disease in Low- and Middle Income Countries”. Current problems in Cardiology, 35(2), 72-115, doi: 10.1016/j. cpcardiol. 2009.10.002.

Gevirtz, R. & Lehrer, P. M. (2003). Resonance frequency heart rate biofeedback.In M.Schwartz & F. Andrasik (Eds.). Biofeedback: A practitioner’s guide (3rd ed. pp. 245-264). New York: Guilford.

Ginsberg, J.P. Berry, M.E & Powell, D.A.)2010). Cardiac coherence and posttraumatic stress disorder in combat veterans.Alternative therapies in health medicine, 16(4), 52-60.

Gullikson, M.; Burell, G.; Vessby, B.; Lundin, L.; Toss, H. & Svardsudd, K. (2011). “Randomized controlled trial of cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease, secondary prevention in Uppsala primary health care project (SUPRIM)”. Archives of Internal Medicine, 171(2), 134-140

Heart,M. (2010). emWave desktop stress relief system: Owner's manual for PC and Mac. Quantum Intech.

Hoogwegt, M.T.; Versteeg, H.; Hansen, T.B.;  Thygesen, L.C.; Pedersen, S.S. & Zwisler, A. (2013). “Exercise mediates the association between positive affect and 5-Year mortality in patients with ischemic heart disease”. Circulation: Cardiovas- cular quality and Outcomes, 6, 559-566.

 

38

Holmes, S.D. Krantz, D.S. Rogers, H. Gottdiener, J. & Contrada, R.J. (2006). “Mental stress and coronary artery disease: a multidisciplinary guide”. Progress in Cardiovascular Disease, 49(2), 106-122.
Kabat-Zinn, J. (2005). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness: Fifteenth anniversary edition. New York: Bantam Dell.

Khazan, I.Z. (2013). Heart rate variability.In Inna Z. Khazan (Ed). The clinical handbook of biofeedback: A step by step guide for training and practice with mindfulness (PP. 97-117) UK: John Wiley & Sons publication.

Kors, J.A. Swenne, C.A. & Greiser, K.H. (2007). “Cardiovascular disease, risk factors, heart rate variability in the general population”. Journal of Electrophysiology.40, S19-S21.

Krygier, J.R.; Heathers, J.A.; Shahrestani, S.; Abbott, M.; Gross, J.j. & Kemp, A.H. (2013). “Mindfulness meditation, well-being and heart rate variability: a preliminary investigation into the impact of intensive Vipassana meditation”. International journal of psychophysiology, 89(3), 305-313.

Lagos, L.;Vaschillo, E.; Vaschillo, B.; Lehrer, P.; Bates, M. & Pandina, R. (2008). “Heart Rate Variability Biofeedback as a Strategy for Dealing with Competitive Anxiety: A Case Study”. Biofeedback, 36(3), 109-115.

 

39

 Lehrer, P. (2007). Biofeedback training to increase heart rate variability. In P. M. Lehrer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and practice of stress management (3rd ed).New York: Guilford Press.
Lehrer, P. (2013a). “How does heart rate variability biofeedback work? resonance, the baroreflex, and other mechanisms”. Biofeedback, 41(1), 26-31. DOI:10.52 98/1081-5937-41.1.02

Lehrer, P. (2013b). “History of Heart Rate Variability Biofeedback Research: A Personal and Scientific Voyage”. Biofeedback, 41(3), 88-97. DOI: 10.5298/ 1081-5937-41.3.03

Lehrer, P.; Vaschillo, E. & Vaschillo, B. (2000). „Resonant breathing biofeedback training to increase cardiac variability: rationale and manual for training”. Applied psychophysiology and Biofeedback, 25, 177 -191.

Lehrer, P.; Vaschillo,; B. Zucker, T.; Graves, J.; Katsamanis, M.; Aviles, M. & Wamboldt, F. (2013). „Protocol for Heart Rate Variability Biofeedback Training”. Biofeedback, 41, 3, 98-109. doi: http:// dx.doi.org/10. 5298/1081-5937 -41.3.08

Mankus, A.M.; Aldao, A.; Kerns, C.; Mayville, E.W. & Mennin, D.S. (2013). “Mindfulness and heart rate variability in individuals with high and low generalized anxiety symptoms”. Behaviour Research and Therapy 51, 386-391. Doi:10.1016/ j.brat.2013. 03.005

Mayers, A. (2013). Analysis of covariance. In A. Mayers (Eds).  Introduction to Statistics and SPSS in Psychology (pp. 362-396). Pearson Education. Harlow.

McCraty R.; Atkinson, M. & Tomasino, D. (2009). “The coherent heart: Heart-brain interactions, psycho

physiological coherence, and the emergence of system-wide order”. Integral Review, 5(2), 10-115.

McCraty, R. (2008). “From depletion to renewal: Positive emotions and heart rhythm coherence feedback”. Biofeedback, 36(1), 30-34.

McCraty, R. &Tomasino, D. (2006). “Coherence-building techniques and heart rhythm coherence feedback: new tools for stress reduction, disease prevention and rehabilitation”. In E. Molinari. A. Compare & G. Parati (Eds.), Clinical psychology and heart disease (pp.487-509). Italy: Springer

Moravec, C.S. (2008). “Biofeedback therapy in cardiovascular disease: Rationale and research overview”. Cleveland clinical journal of medicine, 75 (supple 2).

Moravec, C.S. McKee, M.G. (2011). “Biofeedback in the treatment of heart disease”.Cleveland clinical journal of medicine, 78 (supple 1).

Moss, D. (2004). “Heart rate variability and biofeedback”. Psychophysiology Today: The Magazine for Mind-Body Medicine, 1, 4-11.

Nabipour, I.; Amiri, M.; Imami, S.R.; Jahfari, S.M.; Shafeiae, E.; Nosrati, A.; Iranpour, D. & Soltanian, A.R. (2007). “The metabolic syndrome and nonfatal ischemic heart disease; a population-based study”. International Journal of Cardiology; 118(1), 48-53

Nishith, P.; Duntley, S.P.; Domitrovich, P.P.; Uhles, M.L.; Cook, B.J. & Stein, P.K. (2003). “Effect of cognitive behavioral therapy on heart rate variability during REM sleep in female rape victims with PTSD”. Journal of Traumatic Stress, 16, 247-250.

Nolan, R.P.; Floras, J.S.; Hrvey, P.J.; Kamath, M.V.; Picton, P.E. & et al. (2010). “Behavioral neurocardiac training in hypertension: a randomized, controlled trial”. Hypertension, 55, 1033-1039. doi: 10.1161/ HYPER TENSIONAHA. 109. 146233

 

Nolan, R.P.; Kamath, M.V.; Floras, J.S.; Stanley, J.; Pang, C.; Picton, P. & Young, Q.R. (2005). “Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control”. American Heart Journal, 149(6), 1137.e2-1137.e7.

Orsila, R.; Virtanen, M.; Luukkaala; T.; Tarvainen, M.; Karjalainen, P.; Viik, J.; Savinainen, M. & Nygard, C. (2008).  “Perceived mental stress and reactions in heart rate variability-a pilot study among employees of an electronics company”. International Journal of occupational safety and ergonomics, 14, 275-283.

Powell, L.H. (1996). The hook: a metaphor for gaining control of emotional reactivity. In: Allen R, Scheidt S, (Eds). Heart and mind: The practice of cardiac psychology (pp.313-327). Washington, DC: American Psychological Association .

 

40

Rosengren, A.; Hawken, S.; Ounpuu, S. & et al. (2004). “Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study”. Lancet, 364, 953-62.
Smith, P.J. & Blumenthal, J.A. (2011). “Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment”. Revista Española de Cardiología. 64(10), 924-933. DOI: 10.1016/j.rec.2011.06.003.

Stein, P.K.; Barzilay, J.I.; Chaves, P.H.; Mistretta, S.Q.; Domitrovich, P.P.; Gottdiener, J.S.; Rich, M.W. & Kleiger, R.E. (2008). “Novel measures of heart rate variability predict cardiovascular mortality in older adults independent of traditional cardiovascular risk factors: the cardiovascular health study (CHS)”. Journal of Cardiovascular Electrophysiology , 19, 1169-1174. doi: 10.1111/j.1540-8167.2008. 01232. x.

 Steptoe, A.; Kivimaki, M. (2013). Stress and cardiovascular disease: an update on current knowledge. Annual review of public health, 34, 337-354.Doi: 10.1146/ annurev-publhealth-031912-114452

Steptoe, A.; Wardle, J. & Marmot, M. (2005). “Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes”. PNAS, 102(18), 6508-6512.Doi:10.1073/pnas. 0409174 102.

Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). “Heart rate variability: Standards of measurement, physiological interpretation, and clinical use”. European Heart Journal.  17,354-381.

 

41

Thayer, J.F.; Ahs, F.; Fredrikson, M.; Sollers, J.J. & Wager, T.D. (2012). “A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health”. Neuroscience and Biobehavioral Reviews, 36, 747-756. doi: 10.1016/ j.neubiorev. 2011.11.009.
Thayer, J.F. & Lane, R.D. (2007). “The role of vagal function in the risk for cardiovascular disease and mortality”.Biological Psychology. 74, 224-242.

Thayer, J.F.; Yamamoto, S.S. & Brosschot, J.F. (2010). “The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors”. International Journal of Cardiology, 141, 122-131.

Umetani, K.; Singer, D.H.; McCraty, R. & Atkinson, M. (1998). “Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades”. Journal of American college of cardiology, 31(3), 593-601.

Vaschillo, E.; Lehrer, P.; Rishe, N. & et al. (2002). “Heart rate variability biofeedback as a method for assessing baroreflex function: a preliminary study of resonance in the cardiovascular system”. Applied Psychophysiology and Biofeedback, 27, 1- 27.

Von Kanel, R.; Carney, R.M.; Zhao, S & Whooley, M.A. (2011). “Heart rate variability and biomarkers of systemic inflammation in patients with stable coronary heart disease: finding from the Heart and Soul Study”. Clinical Research in Cardiology, 100(3), 241-247.

Wheat, A.L. & Larkin, K.T. (2010). “Biofeedback of Heart Rate Variability and Related Physiology: A Critical Review”. Applied Psychophisiology and Biofeedback. DOI 10.1007/s10484-010-9133-y.