Improving adherence to physical activity.

Two studies tested the efficacy of Marlatt and Gordon's relapse-prevention approach in increasing attendance during an exercise program (short-term adherence) and continuation of exercise activities for 12 weeks following termination of the formal program (longer term adherence). Participants in both studies were registrants in 10-week exercise groups (jogging, aerobic dance, and pre-ski training) sponsored by the Université de Montréal Sports Centre. The intervention, designed to increase awareness of obstacles to exercise and to develop appropriate techniques for coping with them, was delivered by group leaders within the context of the regular program. Results of both studies indicate a small but consistent superiority of adherence in the experimental condition compared to the control condition. The low cost of this intervention, however, makes even small gains cost effective. Possible methods for strengthening the treatment effect are discussed.

The Montreal Type A Intervention Project: major findings.

This article reports a comparison of three short-term treatments (aerobic exercise, cognitive-behavioral stress management, and weight training) in modifying behavioral and cardiovascular reactivity to laboratory psychosocial stressors in healthy Type A men. One hundred seven men completed the treatments and evaluations, 33 in the aerobic exercise group, and 37 each in the cognitive-behavioral stress management and weight-training groups. The stress management group showed significantly greater changes in behavioral reactivity (reductions of 13% to 23% below initial values) than the two physical exercise groups, which did not differ significantly from each other. For physiological reactivity, changes attributable to intervention were trivial for all three treatment groups. The positive finding of reduced behavioral reactivity as a result of the stress management intervention is of potential clinical significance and warrants further exploration. The lack of meaningful reductions in physiological reactivity also requires further exploration in that it raises questions concerning the ability of behavioral treatments in general to modify physiological reactivity, the ability of existing measures to assess accurately changes that are produced and, most fundamental of all, the relevance of physiological reactivity as an outcome measure for treatment efforts with Type As.

Exaggerated psychophysiological reactivity: issues in quantification and reliability.

Marked physiological reactivity to challenging mental tasks has been associated with elevated risk for, as well as the presence of, coronary heart disease. However, little systematic enquiry into the reliability and quantification of such exaggerated reactivity has emerged. Subjects were 32 male, managerial employees, ranging in age from 22 to 56 yr, who satisfied the following criteria: no history or current signs of heart disease, presence of Type A behavior pattern as revealed by the Structured Interview, and an increase during an initial psychosocial stress testing of at least 25% over baseline in at least three out of five psychophysiological indices. Heart rate, systolic blood pressure, diastolic blood pressure, plasma epinephrine and plasma norepinephrine levels were monitored while challenging mental tasks were performed in three sessions (screening, pretraining and posttraining) spaced several weeks apart. Psychophysiological reactivity during the tasks emerged as a consistent trait. For all five measures, change scores from baseline during the screening session were significantly correlated with change scores during the pretraining session. Moreover, the magnitude of the change scores were similar in the screening and pretraining sessions. Analysis of cross correlations within and between indices provided little support for the use of data transformations such as residual scores or analysis of covariance. Finally, on four out of five measures, the challenging tasks were found to be comparable in the degree of reactivity elicited. These findings suggest that, for selected Type A men, exaggerated psychophysiological reactivity occurs reliably when monitored with multiple indices, appears insensitive to mere passage of time, and can be uniformly elicited by a variety of tasks.

Generalizability and durability of treatment effects in an intervention program for coronary-prone (Type A) managers.

To test the reliability and durability of positive treatment effects obtained in a type A intervention project for healthy managers, the analysis was extended to data available from a third treatment group (a special behavior therapy group for participants eliminated from the main sample because of manifestations of clinical CHD) and to measures obtained 6 months following the end of treatment. Immediately after treatment all three groups showed a similar pattern of improvement, although the two behavior therapy groups did show a greater decrease in serum cholesterol levels. Six months after treatment the sample as a whole showed good maintenance of treatment effects, but the differences between groups had become somewhat sharper, with the special behavior therapy group faring best, the regular behavior therapy group intermediate, and the psychotherapy group worst. The logical consistency of these findings increases our confidence in the initial treatment results, as well as permitting cautious optimism concerning the possibility of developing effective intervention programs for coronary-type (type A) behavior.

Increasing maternal participation in the hospitalization of young children.

In an attempt to reduce the harmful emotional effects of separation for young children, hospitals in recent years have liberalized visiting hours, but parents have not taken advantage of their new privileges. The study described here sought to increase mothers' participation in their children's hospitalization by overcoming some of the psychological barriers believed to exist. The mothers of 48 children aged 1 to 5, to be admitted for elective surgery to a large, metropolitan pediatric hospital, constituted the primary sample and were divided into experimental and control groups. Mothers in the experimental group had an extra half-hour session in a pre-admission interview focusing on visiting, and specific suggestions were made about frequency and timing of visits, as well as the role of the mother during her visits. During the experimental period weekly meetings were held with the nursing staff to enlist their support for this change in visiting patterns. Results indicate that duration of visits, timing of visits, and behavior during them were all significantly modified for the experimental group of mothers. In contrast, the nurses did not significantly change their relationship with the mothers or the children. Clinical possibilities and limitations of such a program are discussed.

Changing the coronary-prone (type A) behavior pattern in a nonclinical population.

This report presents the design and initial findings of an attempt to reduce the risk of coronary heart disease in healthy men by modifying their type A behavior pattern. A group of 27 professional and executive volunteers, aged 39--59, who had been medically assessed as free from coronary heart disease, were randomly assigned to brief psychotherapy and behavior therapy groups. Each treatment group met for 14 sessions over a period of 5 months. Pre- and postmeasures of physiological (serum cholesterol, serum triglycerides, blood pressure) and psychological (anxiety, psychological symptoms, satisfaction) variables were taken. Results indicate that both treatment groups changed in the desired direction on most of the psychological and physiological variables without apparent change in habits of diet, exercise, smoking, or work load. The findings are provocative, but only tentative, leaving questions of clinical validity, durability, and generalizability unresolved. Nevertheless, they indicate that this approach to modifying type A behavior may reduce coronary risk and therefore warrants further exploration.

Emergency hospitalization of young children: some neglected psychological considerations.

In spite of the fact that emergency admission is the most common form of hospitalization for young children, as well as containing the greatest potential for trauma, almost no reference has been made to it in the psychological literature on pediatric hospitalization. To explore the theoretical and practical feasibility of research in this area, a pilot study was designed to investigate the reactions of a sample of children, parents, and staff to the first six hours of emergency hospitalization, compared with those of a similar sample to elective admission. Sixteen children (eight in each group) aged 11 to 48 months were selected on a time-sample basis from the patient population of a large, metropolitan, pediatric hospital and were followed by trained observors using a specially designed observation schedule. The results indicated that, as expected, emergency does constitute an even greater stress for children, parents, and staff that the already stressful situation of elective admission. In both conditions however, the results were more complex and more disturbing than anticipated. The implications of these findings, as well as suggestions for further research, are discussed.