Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees.

OBJECTIVES This study examined the impact of a workplace-based stress management program on blood pressure (BP), emotional health, and workplace-related measures in hypertensive employees of a global information technology company. DESIGN Thirty-eight (38) employees with hypertension were randomly assigned to a treatment group that received the stress-reduction intervention or a waiting control group that received no intervention during the study period. The treatment group participated in a 16-hour program, which included instruction in positive emotion refocusing and emotional restructuring techniques intended to reduce sympathetic nervous system arousal, stress, and negative affect, increase positive affect, and improve performance. Learning and practice of the techniques was enhanced by heart rate variability feedback, which helped participants learn to self-generate physiological coherence, a beneficial physiologic mode associated with increased heart rhythm coherence, physiologic entrainment, parasympathetic activity, and vascular resonance. BP, emotional health, and workplace-related measures were assessed before and 3 months after the program. RESULTS Three months post-intervention, the treatment group exhibited a mean adjusted reduction of 10.6 mm Hg in systolic BP and of 6.3 mm Hg in diastolic BP. The reduction in systolic BP was significant in relation to the control group. The treatment group also demonstrated improvements in emotional health, including significant reductions in stress symptoms, depression, and global psychological distress and significant increases in peacefulness and positive outlook. Reduced systolic BP was correlated with reduced stress symptoms. Furthermore, the trained employees demonstrated significant increases in the work-related scales of workplace satisfaction and value of contribution. CONCLUSIONS Results suggest that a brief workplace stress management intervention can produce clinically significant reductions in BP and improve emotional health among hypertensive employees. Implications are that such interventions may produce a healthier and more productive workforce, enhancing performance and reducing losses to the organization resulting from cognitive decline, illness, and premature mortality.

[1]  Barry M. Staw,et al.  Affect and favorable work outcomes: two longitudinal tests of the happy–productive worker thesis , 1999 .

[2]  A. Steptoe Stress mechanisms in hypertension. , 1986, Postgraduate medical journal.

[3]  A. Isen,et al.  Positive affect facilitates creative problem solving. , 1987, Journal of personality and social psychology.

[4]  Mara Olekalns,et al.  Affectivity, Organizational Stressors, and Absenteeism: A Causal Model of Burnout and Its Consequences , 1998 .

[5]  M. Chesney,et al.  Relaxation Therapy for Hypertension: Design Effects and Treatment Effects , 1991 .

[6]  L. F. Barrett,et al.  Handbook of emotions, 2nd ed. , 2000 .

[7]  Heart Rhythm Coherence - An Emerging Area of Biofeedback , 2002 .

[8]  M. Clement,et al.  PREVENTION AND TREATMENT , 1944 .

[9]  M. Schroll,et al.  Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. , 1996, Circulation.

[10]  D. Johnston Psychological perspectives of essential hypertension. etiology, maintenance and treatment , 1985 .

[11]  D. Childre,et al.  The Grateful Heart: The Psychophysiology of Appreciation. , 2004 .

[12]  K. Matthews,et al.  Psychological predictors of hypertension in the Framingham Study. Is there tension in hypertension? , 1993, JAMA.

[13]  Mary E. Martin Management of the , 2005 .

[14]  A. P. Shapiro Hypertension and Stress: A Unified Concept , 1996 .

[15]  J. Cutler,et al.  Obesity and hypertension: epidemiological and clinical issues. , 1987, European heart journal.

[16]  Rollin McCraty,et al.  MUSIC ENHANCES THE EFFECT OF POSITIVE EMOTIONAL STATES ON SALIVARYIgA , 1996 .

[17]  R. Schneider,et al.  A Randomized Controlled Trial of Stress Reduction for Hypertension in Older African Americans , 1995 .

[18]  R. Collins,et al.  Blood pressure, stroke, and coronary heart disease Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context , 1990, The Lancet.

[19]  R. Collins,et al.  Blood pressure, stroke, and coronary heart disease Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias , 1990, The Lancet.

[20]  J. George,et al.  Feeling good-doing good: a conceptual analysis of the mood at work-organizational spontaneity relationship. , 1992, Psychological bulletin.

[21]  W Linden,et al.  Individualized stress management for primary hypertension: a randomized trial. , 2001, Archives of internal medicine.

[22]  D. Johnston Stress management in the treatment of mild primary hypertension. , 1991, Hypertension.

[23]  D. Childre,et al.  The HeartMath Solution , 1999 .

[24]  D. Seals,et al.  The ‘adrenaline hypothesis’ of hypertension revisited: evidence for adrenaline release from the heart of patients with essential hypertension , 2000, Journal of hypertension.

[25]  Rollin McCraty,et al.  AN INNER QUALITY APPROACH TO REDUCING STRESS AND IMPROVING PHYSICAL AND EMOTIONAL WELLBEING AT WORK , 1997 .

[26]  A. Rush,et al.  Workplace performance effects from chronic depression and its treatment. , 1998, Journal of health economics.

[27]  J. Staessen,et al.  A meta-analysis of outcome trials in elderly hypertensives. , 1992, Journal of hypertension.

[28]  S. Weiss,et al.  Stress management in the treatment of hypertension. , 1988, American heart journal.

[29]  Robert I. Sutton,et al.  Employee Positive Emotion and Favorable Outcomes at the Workplace , 1994 .

[30]  J Wasserman,et al.  The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database. , 1998, Journal of occupational and environmental medicine.

[31]  A. Isen,et al.  The Influence of Positive Affect and Visual Access on the Discovery of Integrative Solutions in Bilateral Negotiation , 1986 .

[32]  P. Elliott,et al.  An Overview of Randomized Trials of Sodium Reduction and Blood Pressure , 1991, Hypertension.

[33]  T. Dalgleish,et al.  Handbook of cognition and emotion , 1999 .

[34]  R. Havlik,et al.  The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. , 1995, JAMA.

[35]  T. Beckman,et al.  A pilot intervention program that reduces psychological symptomatology in individuals with human immunodeficiency virus , 1996 .

[36]  S. Julius,et al.  Sympathetic Hyperactivity in Early Stages of Hypertension: The Ann Arbor Data Set , 1988, Journal of cardiovascular pharmacology.

[37]  R. Mccraty,et al.  The effects of emotions on short-term power spectrum analysis of heart rate variability . , 1995, The American journal of cardiology.

[38]  M. Csíkszentmihályi,et al.  Positive psychology. An introduction. , 2000, The American psychologist.

[39]  W. Linden,et al.  Clinical Effectiveness of Non-Drug Treatment for Hypertension: a Meta-Analysis , 1994, Annals of Behavioral Medicine.

[40]  J. George State or trait: Effects of positive mood on prosocial behaviors at work. , 1991 .

[41]  N. Frasure-smith,et al.  Depression and 18-month prognosis after myocardial infarction. , 1995, Circulation.

[42]  M. Atkinson,et al.  Emotional Self-Regulation Program Enhances Psychological Health and Quality of Life in Patients with Diabetes , 2000 .

[43]  J. M. Woodward,et al.  Effect of “Mood That Day” on Pharmacists' Job and Career Satisfaction , 1994, Psychological reports.

[44]  Rollin McCraty,et al.  The impact of a new emotional self-management program on stress, emotions, heart rate variability, DHEA and cortisol , 1998, Integrative physiological and behavioral science : the official journal of the Pavlovian Society.

[45]  W. Friesen,et al.  PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES Positive Emotions in Early Life and Longevity : Findings from the Nun Study , 2004 .

[46]  Detection The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) , 1997 .

[47]  R. Mccraty,et al.  Cardiac coherence: a new, noninvasive measure of autonomic nervous system order. , 1996, Alternative therapies in health and medicine.

[48]  Michael E. McCullough,et al.  The Psychology of Gratitude , 2004 .

[49]  D. Goldberg,et al.  Depressive symptoms and increased risk of stroke mortality over a 29-year period. , 1998, Archives of internal medicine.

[50]  R. Golembiewski Handbook of Organizational Behavior , 2001 .

[51]  J. Henry,et al.  Psychosocial hypertension and the defence and defeat reactions. , 1986, Journal of hypertension.

[52]  S Cerutti,et al.  Sympathetic predominance in essential hypertension: a study employing spectral analysis of heart rate variability. , 1988, Journal of hypertension.

[53]  P. Baer,et al.  Stress Management at the Worksite for Hypertension: Compliance, Cost‐Benefit, Health Care and Hypertension‐Related Variables , 1984, Psychosomatic medicine.

[54]  R. Fagard Physical exercise in the management of Hypertension. A consensus statement by the World Hypertension League , 1991 .

[55]  M. Atkinson,et al.  The Effect of Employee Self-Management Training on Personal and Organizational Quality: (537382011-001) , 1999 .

[56]  A. Isen,et al.  Positive affect and decision making. , 1993 .

[57]  State-specific trends in self-reported blood pressure screening and high blood pressure--United States, 1991-1999. , 2002, MMWR. Morbidity and mortality weekly report.

[58]  Barbara L. Fredrickson,et al.  Why positive emotions matter in organizations: Lessons from the broaden-and-build model. , 2000 .

[59]  D. Bassett,et al.  Behavioral factors in hypertension , 1987 .

[60]  Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group. , 1979, JAMA.

[61]  Béla Ágai,et al.  CONDENSED 1,3,5-TRIAZEPINES - V THE SYNTHESIS OF PYRAZOLO [1,5-a] [1,3,5]-BENZOTRIAZEPINES , 1983 .

[62]  M. Schalekamp,et al.  ADRENALINE, STRESS, AND HYPERTENSION , 1983, The Lancet.

[63]  W N Burton,et al.  The role of health risk factors and disease on worker productivity. , 1999, Journal of occupational and environmental medicine.

[64]  David L. Cooperrider,et al.  Appreciative Inquiry: A Positive Revolution in Change , 2005 .

[65]  C. Mathias,et al.  Management of hypertension by reduction in sympathetic activity. , 1991, Hypertension.

[66]  H. Rüddel,et al.  Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress. , 1994, American heart journal.

[67]  Alexander J. Rothman,et al.  Emotional states and physical health. , 2000, The American psychologist.

[68]  Barbara L. Fredrickson,et al.  Cultivating Positive Emotions to Optimize Health and Well-Being , 2000 .

[69]  R. Jacob,et al.  Nonpharmacologic approaches to the treatment of hypertension. , 1983, Annual review of public health.

[70]  D. Levine,et al.  A neuropsychological theory of positive affect and its influence on cognition. , 1999, Psychological review.

[71]  C. DeCarli,et al.  Association of midlife blood pressure to late-life cognitive decline and brain morphology , 1998, Neurology.

[72]  P. Lehrer,et al.  Respiratory Sinus Arrhythmia Biofeedback Therapy for Asthma: A Report of 20 Unmedicated Pediatric Cases Using the Smetankin Method , 2000, Applied psychophysiology and biofeedback.

[73]  Sigal G. Barsade,et al.  Affect and managerial performance: A test of the sadder-but-wiser vs. happier-and-smarter hypotheses. , 1993 .

[74]  Naphtali Rishe,et al.  Heart Rate Variability Biofeedback as a Method for Assessing Baroreflex Function: A Preliminary Study of Resonance in the Cardiovascular System , 2002, Applied psychophysiology and biofeedback.

[75]  W. Haskell,et al.  A controlled pilot study of stress management training of elderly patients with congestive heart failure. , 2002, Preventive cardiology.