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Biomedical subjects

A D Domar

Publications and source records attributed to A D Domar.

17 recordsLinked to original sources
PubMed2000

Impact of group psychological interventions on pregnancy rates in infertile women.

OBJECTIVE: To determine the efficacy of two different group psychological interventions on viable pregnancy rates in women experiencing infertility of less than 2 years' duration. DESIGN: Prospective, controlled, single-blind, randomized study. SETTING: Large tertiary-care teaching hospital. PATIENT(S): One hundred eighty-four women who had been trying to get pregnant for 1 to 2 years. INTERVENTION(S): Participants were randomized into a 10-session cognitive-behavioral group, a standard support group, or a routine care control group. They were followed for 1 year. MAIN OUTCOME MEASURE(S): Viable pregnancy. RESULT(S): Sixty-four [corrected] women discontinued participation in the study within the first year. There were a total of 47 in the cognitive-behavioral group, 48 in the support group, and 25 in the control group. There were statistically significant differences between participants in the two intervention groups versus the control group. CONCLUSION(S): Group psychological interventions appear to lead to increased pregnancy rates in infertile women.

Adult↗
PubMed2000

The impact of group psychological interventions on distress in infertile women.

Infertile women express higher levels of distress than fertile women, with distress peaking between the 2nd and 3rd year. The purpose of this study was to determine whether group psychological interventions could prevent this surge. One hundred eighty-four women who had been trying to conceive between 1 and 2 years were randomized into either a cognitive-behavioral group, a support group, or a control group. All experimental participants attended a 10-session group program. Participants completed psychological questionnaires at intake and again at 6 and 12 months. Substantial attrition occurred, particularly in the control group. The cognitive-behavioral and support participants experienced significant psychological improvement at 6 and 12 months compared with the control participants, with the cognitive-behavioral participants experiencing the greatest positive change.

Adult↗
PubMed1999

Distress and conception in infertile women: a complementary approach.

OBJECTIVES: To examine the relationship of pretreatment psychological distress and demographics to conception in infertile women attending a group cognitive-behavioral treatment program. METHODS: Pre- and postprogram psychological measures and live birth rates were collected for 132 infertile women attending a ten-session group cognitive-behavioral treatment program. Subjects completed the Beck Depression Inventory (BDI) and the Symptom Checklist-90 (Revised) (SCL-90R). Conceptions that resulted in live births within six months of completing the program were noted. RESULTS: Women who conceived viable pregnancies within six months of the program had higher levels of psychological distress at program entry. Using logistic regression analysis, the best predictors of viable birth were younger age and a higher score on the global severity index of the SCL-90R. Significant pre- to postprogram psychological improvement was demonstrated by the SCL-90R and the BDI. Forty-two percent of the sample conceived viable pregnancies within six months of completing the program. CONCLUSIONS: Preprogram psychological distress and younger age were associated with significantly higher viable pregnancy rates.

Adult↗
PubMed1996

The efficacy of relaxation response interventions with adult patients: a review of the literature.

The relaxation response is an integrated psycho-physiologic response originating in the hypothalamus that leads to a generalized decrease in arousal of the central nervous system. As such it is the physiologic antithesis of the stress response. This hypometabolic state is the foundation of many nursing interventions. Relaxation interventions have been taught for centuries. They include many theoretic and philosophic traditions and an array of specific strategies. The possible outcomes using relaxation response strategies in nursing practice are numerous and enable the patient to use the body's own innate mechanisms for health and healing. Thirty-seven studies of the efficacy of relaxation response interventions with adult patients are reviewed. Although numerous patient populations are addressed by the studies, some of which have methodologic problems, consistencies in the results suggest the effectiveness of the relaxation response in reducing hypertension, insomnia, anxiety, pain, and medication use across multiple populations, diagnostic categories, and settings. Recommendations for the use of relaxation responses in varied clinical settings are included.

Adult↗
PubMed1996

The effects of relaxation response training on menopausal symptoms.

The specific aim of this study was to investigate the efficacy of elicitation of the relaxation response for the treatment of menopausal hot flashes and concurrent psychological symptoms. The volunteer sample consisted of 33 women, between the ages of 44 and 66 years, who were in general good health, with a minimum of 6 months without a menstrual period, experiencing at least five hot flashes per 24-h, and not using hormone replacement therapy. The setting was an outpatient clinic in a tertiary care teaching hospital. The interventions used were relaxation response training and an attention-control group and a daily symptom diary measuring both the frequency and intensity of hot flashes, the Spielberger State-Trait Anxiety Inventory (STAI), and the Profile of Mood Scale (POMS) were the measures used. This was a randomized, controlled, prospective study. Subjects were randomly assigned to one of three groups (relaxation response, reading, or control) for the 10-week study. The first 3 weeks of baseline measurement of frequency and intensity of hot flash symptoms, and the preintervention psychological scores were compared with the final 3 weeks measurement of frequency and intensity and the postintervention psychological scores for symptomatic improvement. The relaxation response group demonstrated significant reductions in hot flash intensity (p < 0.05), tension-anxiety (p < 0.05) and depression (p < 0.05). The reading group demonstrated significant reductions in trait-anxiety (p < 0.05) and confusion-bewilderment (p < 0.05). There were no significant changes for the control group. Daily elicitation of the relaxation response leads to significant reductions in hot flash intensity and the concurrent psychological symptoms of tension-anxiety and depression.

Affect↗
PubMed1993

Multifactor behavioral treatment of chronic sleep-onset insomnia using stimulus control and the relaxation response. A preliminary study.

Sleep latency changes following behavioral interventions for sleep-onset insomnia are only moderate because the majority of insomniacs do not achieve good sleeper status at posttreatment. This study evaluated the efficacy of a multifactor behavior intervention consisting of stimulus control and relaxation-response training (n = 10) compared to stimulus control alone (n = 10) for sleep-onset insomnia. Only the multifactor subjects' mean posttest sleep latency fell within the good sleeper range. They also exhibited a 77% improvement on mean sleep-onset latency compared to the stimulus control group (63%). Thus a multifactor intervention may be more effective than stimulus control alone for treatment of sleep-onset insomnia.

Adult↗
PubMed1993

The psychological impact of infertility: a comparison with patients with other medical conditions.

To compare the psychological symptoms of infertile women with patients with other chronic medical conditions, subjects completed the Symptom Checklist-90 (Revised) (SCL-90R), a standardized, validated and widely used psychological questionnaire, prior to enrolling in a group behavioral treatment program. All subjects were female and the totals in each program were as follows: 149 with infertility, 136 with chronic pain, 22 undergoing cardiac rehabilitation, 93 with cancer, 77 with hypertension, and 11 with human immunodeficiency virus (HIV)-positive status. The infertile women had global symptom scores equivalent to the cancer, cardiac rehabilitation and hypertension patients, but lower scores than the chronic pain and HIV-positive patients (p < 0.0001 and p < 0.02 respectively). The anxiety and depression scores of the infertile women were significantly lower than chronic pain patients but not statistically different from the other groups. The results suggest that the psychological symptoms associated with infertility are similar to those associated with other serious medical conditions. Therefore, standard psychosocial interventions for serious medical illness should also be applied in infertility treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Clinical application of the relaxation response in women's health.

Women are subject to multiple stressors and often get little recognition or support for their diverse roles. Although stress is a natural part of life, research indicates that prolonged or extreme stress can have a negative effect on a woman's health. Nurses, because of their holistic approach, are ideally suited to use interventions that empower women to deal effectively with stress. This article outlines the mind/body connection and describes the relaxation response as a counterbalance to the deleterious effects of stress. Instructions for several methods of using the relaxation response in a clinical setting are given.

Female↗
PubMed1992

The prevalence and predictability of depression in infertile women.

OBJECTIVE: To determine the prevalence, severity, and predictability of depression in infertile women compared with a control sample of healthy women. DESIGN: Subjects were assessed while waiting to see their physician: infertility patients before a visit with an infertility specialist and control subjects before seeing either a gynecologist or internist for a routine gynecological examination. Subjects completed a demographic form and two depression scales. SETTING: A group infertility practice affiliated with an academic medical center, a hospital-based gynecology practice, and a health maintenance organization internal medicine clinic. PARTICIPANTS: 338 infertile women and 39 healthy women. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale. RESULTS: The infertile women had significantly higher depression scores and twice the prevalence of depression than the controls; women with a 2- to 3-year history of infertility had significantly higher depression scores compared with women with infertility durations of < 1 year or > 6 years; women with an identified causative factor for their infertility had significantly higher depression scores than women with unexplained or undiagnosed infertility. CONCLUSIONS: Depressive symptoms are common in infertile women. Psychological interventions aimed at reducing depressive symptoms need to be implemented, especially for women with a definitive diagnosis and for those with durations of 2 to 3 years of infertility.

Depression↗
PubMed1992

Psychological improvement in infertile women after behavioral treatment: a replication.

OBJECTIVE: To replicate previously reported psychological improvements in infertile women attending a group behavioral treatment program. DESIGN: Psychological and demographic data were collected before entering and again upon completion of a behavioral medicine program on a second cohort of patients. SETTING: The program was offered in the Division of Behavioral Medicine, an outpatient clinic of the Department of Medicine at New England Deaconess Hospital. All patients were receiving care from infertility specialists not affiliated with this hospital. PATIENTS: Fifty two self-referred women receiving medical treatment for infertility attended the program. INTERVENTION: A 10-week group behavioral treatment program. MAIN OUTCOME MEASURES: Three validated psychological instruments. RESULTS: Psychological improvement was statistically significant (Profile of Mood States Tension/Anxiety: P less than 0.0001; Depression/Dejection: P less than 0.0122; Vigor/Activity: P less than 0.0431; Confusion/Bewilderment: P less than 0.0057; Spielberger Anger Expression: P less than 0.0013; Spielberger State Anxiety: P less than 0.0037, and Trait Anxiety: P less than 0.0001). CONCLUSIONS: Behavioral treatment is associated with significant decreases in negative psychological symptoms.

Adult↗
PubMed1990

The mind/body program for infertility: a new behavioral treatment approach for women with infertility.

There is increasing evidence that a behavioral treatment approach might be efficacious in the treatment of the emotional aspects of infertility and may lead to increased conception rates. The first 54 women to complete a behavioral treatment program based on the elicitation of the relaxation response showed statistically significant decreases in anxiety, depression, and fatigue as well as increases in vigor. In addition, 34% of these women became pregnant within 6 months of completing the program. These findings established a role for stress reduction in the long-term treatment of infertility. They further suggest that behavioral treatment should be considered for couples with infertility before or in conjunction with reproductive technologies such as intrauterine insemination and gamete intrafallopian transfer.

Cognition↗
PubMed1990

Relaxation response in femoral angiography.

Immediately before they underwent femoral angiography, 45 patients were given one of three types of audiotapes: a relaxation response tape recorded for this study, a tape of contemporary instrumental music, or a blank tape. All patients were instructed to listen to their audiotape during the entire angiographic procedure. Each audiotape was played through earphones. Radiologists were not told the group assignment or tape contents. The patients given the audiotape with instructions to elicit the relaxation response (n = 15) experienced significantly less anxiety (P less than .05) and pain (P less than .001) during the procedure, were observed by radiology nurses to exhibit significantly less pain (P less than .001) and anxiety (P less than .001), and requested significantly less fentanyl citrate (P less than .01) and diazepam (P less than .01) than patients given either the music (n = 14) or the blank (n = 16) control audiotapes. Elicitation of the relaxation response is a simple, inexpensive, efficacious, and practical method to reduce pain, anxiety, and medication during femoral angiography and may be useful in other invasive procedures.

Angiography↗
PubMed1990

Alleviation of premenstrual syndrome symptoms with the relaxation response.

During a 5-month study, we examined the effects of the relaxation response on premenstrual syndrome in 46 women who were randomly assigned to one of three groups: a charting group, a reading group, and a relaxation response group. The relaxation response group showed significantly greater improvement than the charting and the reading groups on physical symptoms (P less than .025 for both comparisons). There was a significant group-by-severity effect for charting versus relaxation response and for reading versus relaxation response on symptoms measured daily (P less than .01 for both comparisons), on emotional symptoms measured retrospectively (P less than .001 and P less than .025, respectively), and on symptoms of social withdrawal measured retrospectively (P less than .01 and P less than .025, respectively). Women with severe symptoms in the relaxation response group showed a 58.0% improvement, compared with a 27.2% improvement for the reading group and a 17.0% improvement for the charting group. We conclude that regular elicitation of the relaxation response is an effective treatment for physical and emotional premenstrual symptoms, and is most effective in women with severe symptoms.

Adult↗
PubMed1989

Preoperative anxiety: is it a predictable entity?

Most surgical and anesthesia personnel assume that certain factors lead to increased preoperative anxiety, yet the predictability of preoperative anxiety has not been extensively studied. We hypothesized that surgical and anesthesia personnel could be more effective in reducing preoperative anxiety if potential predictors of presurgical anxiety were identified. A sample of 523 patients awaiting elective surgery completed an anxiety scale, had their blood pressure and pulse measured, and had 14 different characteristics recorded. These characteristics included demographics, possibility of cancer, presence of support person, previous surgical experience, and extent of surgery. Female patients were more anxious than male patients, and individuals accompanied by a support person were more anxious than those not accompanied. However, all other factors were noncontributory to anxiety. It appears that patient anxiety does not reflect the assumptions of surgical and anesthesia personnel. This suggests that preoperative anxiety may reflect a patient's personality and coping style more than medical data.

Anxiety↗
PubMed1987

The preoperative use of the relaxation response with ambulatory surgery patients.

The efficacy of the regular elicitation of the relaxation response in reducing surgical anxiety and pain in an ambulatory surgery setting was studied in a population of patients scheduled for the surgical removal of a skin cancer. Forty-nine patients with skin cancer were enrolled in the study immediately after being informed of the ned for surgery; 21 of these patients elicited the relaxation response 20 minutes per day until the day of surgery, 21 read for 20 minutes per day, and 7 were noncompliant and were excluded from the study. Contrary to expectations, neither group of patients showed any increase in anxiety immediately before or after surgery on either psychological or physiological measures. Thus, there were no differences between the two groups on any of the psychological or physiological measures of anxiety, nor were there any differences in pain perception. There were statistically significant subjective differences; the experimental patients stated that the relaxation-response technique had reduced their anxiety several days before surgery and reportedly experienced their highest levels of anxiety prior to entering the study, while the controls experienced their highest levels of anxiety during and after surgery. This suggests that (1) minor outpatient surgery does not lead to detectable increased anxiety levels on the day of surgery and (2) regular elicitation of the relaxation response can alter subjective reports of distress associated with surgery.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Psychological aspects of the pelvic exam: individual needs and physician involvement.

Many women are traumatized by pelvic examinations, resulting in reactions ranging from mild anxiety and embarrassment to avoiding the exam altogether. Studies which surveyed how women feel about pelvic exams are discussed and analyzed as are projects utilizing the educational pelvic exam approach. The concept of psychological preparation for pelvic exams is presented incorporating the importance of personal control. The main theme is the proposal that preparation for pelvic exams should be tailored to each individual patient. The role of the examiner is also discussed, stressing physician education and sexual conflicts involved in the performance of pelvic exams.

Adaptation, Psychological↗