A healthy aging program for older adults: effects on self-efficacy and morale.

CONTEXT: As of 2012, 810 million people worldwide were older than 60 y, accounting for 11% of the population. That number is expected to rise to 2 billion by 2050 or to 22% of the overall population. As a result, a growing need exists to understand the factors that promote mental and physical health in older populations. OBJECTIVES: The purpose of this study was to develop a healthy aging program for older adults and to measure the changes from baseline to the end of the program in participants' relevant psychosocial outcomes (ie, self-efficacy and morale). DESIGN: The study's healthy aging mind-body intervention (MBI) was adapted from the Relaxation Response Resiliency Program (3RP) at the Benson-Henry Institute for Mind Body Medicine, which incorporates elements from the fields of stress management, cognitive behavioral therapy, and positive psychology. That program was modified with examples and exercises targeted to an older population and evaluated in the current single-arm pilot study. SETTING: The program took place at the Massachusetts General Hospital (MGH). PARTICIPANTS: The 9-wk healthy aging MBI was developed for participants aged 65 y and older. Fifty-one older adults from the surrounding community participated in the study's groups. INTERVENTION: A new intervention group began the program every 3 mo, with a maximum of 12 individuals per group. For each group, the MBI consisted of weekly 90-min sessions for 9 consecutive wk, directed by a psychologist. The program included sessions that taught participants (1) a variety of methods to elicit the relaxation response (RR), (2) the practice of adaptive coping and cognitions, (3) behaviors necessary to create a healthy lifestyle, and (4) methods of building social support. OUTCOME MEASURES: The research team chose to focus on 2 psychological variables of interest for aging populations: morale and self-efficacy. The study used 2 questionnaires to measure those outcomes, the Philadelphia Geriatric Center Morale Scale (PGCMS), a multidimensional measure of the psychological state of older people, and the Coping Self-efficacy Scale (CSES), a measure that addresses the multiple dimensions of self-efficacy. RESULTS: Data from 5 intervention groups were combined for the current analysis. Forty-six participants enrolled and completed questionnaires. Of those participants, 41 attended at least 7 of the 9 sessions. Significant increases in self-efficacy and morale were observed for program completers. After a highly conservative sensitivity analysis, the change for the measure of self-efficacy remained significant, and the change for the measure of morale trended toward significance. CONCLUSIONS: The study's healthy aging program appears to be a feasible intervention for older adults, with the potential to increase levels of self-efficacy and morale in participants. Further research is warranted to determine its effects on other psychosocial outcomes and health care utilization in aging populations.

A relaxation response training for women undergoing breast biopsy: exploring integrated care.

BACKGROUND: Recent changes in clinical guideline recommendations for age of breast cancer screening initiation highlighted the potential psychological ramifications associated with screening. This study examined the feasibility, acceptability, and preliminary efficacy of a brief Relaxation Response training (RRT) to decrease distress among women undergoing breast biopsy. METHODS: Women scheduled for percutaneous core-needle biopsy were recruited into a single-arm RRT trial, including 3 individual sessions. Psychosocial assessments were completed pre- and postintervention. RESULTS: Forty women were enrolled between 6/1/10 and 8/31/11. Among enrollees, 75% completed all 3 RRT sessions, and 75% completed the post-assessment. Participants showed significant reductions in acute distress following each RRT session. Qualitative feedback indicated a positive impact of RRT on clinic care experiences. CONCLUSIONS: RRT is a portable intervention that was feasible to implement, acceptable to patients and associated with significant decreases in acute emotional distress during the period of diagnostic uncertainty related to percutaneous breast biopsy.

Effects of complementary therapies on clinical outcomes in patients being treated with radiation therapy for prostate cancer.

BACKGROUND: This pilot randomized controlled trial (RCT) examined the clinical effects of 2 complementary (CAM) therapies, relaxation response therapy (RRT) and Reiki therapy, in men being treated with external beam radiotherapy (EBRx) for prostate cancer. METHODS: Study participants were randomly assigned to weekly RRT, Reiki therapy twice weekly, or wait-list control. Well-validated instruments measured anxiety (STAI), depression (CES-D), and quality of life in cancer patients (FACT-G) at randomization and 3 subsequent time points. RESULTS: Fifty-four men were randomized, and 16 of 18 (89%) of RRT and 15 of 18 (83%) of Reiki patients completed the intervention protocol. No statistically significant difference was found between the RRT, Reiki, and control groups on total scores for the STAI, CES-D, or FACT-G instruments at any time point. However, at the end of the intervention, significant improvement was found on the emotional well-being subscale of the FACT-G quality of life scale in the RRT group compared with the Reiki and control groups (P = .01). In participants who were classified as "anxious" at baseline, statistically significant improvement occurred in the RRT group (P = .02), and a positive trend was found in the Reiki group (P = .10). CONCLUSIONS: This pilot study documented the feasibility of conducting a RCT of CAM therapies in men undergoing EBRx for prostate cancer. Relaxation response therapy improved emotional well being and eased anxiety in participants. Reiki therapy also had a positive effect in anxious patients. A larger study to verify and better define the benefits of these therapies in men with prostate cancer is warranted.

A behavioral-medicine program in HIV. Implications for quality of life.

The purpose of this descriptive study is to examine quality of life issues in participants in a behavioral-medicine group (N = 24). Of the sample, 60% indicated current use of complementary therapies. Sexual functioning, a subscale of the quality-of-life measure, was positively correlated with length of time with HIV. CD4+ lymphocyte counts were not significantly correlated with quality of life (QOL). Viral load (VL) was positively correlated with the social-support subscale of the QOL scale. Use of body therapies (massage, acupuncture) was associated with social functioning and use of nutritional therapies was associated with mental health. Results of the study indicate that clinical interventions, including behavioral-medicine interventions and complementary therapies for persons with HIV/AIDS, can result in greater QOL.