Skip to main content
Erschienen in: Annals of Behavioral Medicine 3/2009

01.06.2009 | Original Article

Physiological Correlates of Applied Tension May Contribute to Reduced Fainting During Medical Procedures

verfasst von: Blaine Ditto, Ph.D., Nelson Byrne, Ph.D., Crystal Holly, B.Sc.

Erschienen in: Annals of Behavioral Medicine | Ausgabe 3/2009

Einloggen, um Zugang zu erhalten

Abstract

Background

Applied tension (AT) is a behavioral technique used to reduce symptoms such as dizziness and fainting in people with blood and injury phobias as well as medical patients undergoing invasive procedures. AT has been found to reduce dizziness and fainting in several studies of blood donors.

Purpose

The purpose of this study was to examine the psychophysiological effects of AT in the context of blood donation.

Methods

Ninety-eight young adult blood donors wore ambulatory physiological monitors and were randomly assigned to one of two groups that practiced AT or one that did not. Measures of blood pressure, heart rate, stroke volume, and other physiological parameters were obtained while participants gave blood.

Results

Donors who did not practice AT were more likely to report symptoms in the donation chair and generally displayed a pattern of physiological activity consistent with risk for a vasovagal reaction. For example, heart rate and total peripheral resistance decreased. The drop in heart rate was probably due at least in part to an increase in vagal parasympathetic nervous system activity, as suggested by an increase in high-frequency heart rate variability. In contrast, donors who practiced AT displayed stable heart rate and high-frequency heart rate variability.

Conclusions

The results suggest that the physiological effects of AT, particularly the inhibition of vagal activity, interfere with those promoting a vasovagal reaction. There may be a number of useful applications for AT in medical settings.
Literatur
1.
Zurück zum Zitat Kozak M, Montgomery GK. Multimodal behavioral treatment of recurrent injury-scene-elicited fainting (vasodepressor syncope). Behav Psychother. 1981; 9: 316-321.CrossRef Kozak M, Montgomery GK. Multimodal behavioral treatment of recurrent injury-scene-elicited fainting (vasodepressor syncope). Behav Psychother. 1981; 9: 316-321.CrossRef
2.
Zurück zum Zitat Ost LG, Sterner U. Applied tension. A specific behavioral method for treatment of blood phobia. Behav Res Ther. 1987; 25: 25-29.PubMedCrossRef Ost LG, Sterner U. Applied tension. A specific behavioral method for treatment of blood phobia. Behav Res Ther. 1987; 25: 25-29.PubMedCrossRef
3.
Zurück zum Zitat Ost LG, Fellenius J, Sterner U. Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia. Behav Res Ther. 1991; 29: 561-574.PubMedCrossRef Ost LG, Fellenius J, Sterner U. Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia. Behav Res Ther. 1991; 29: 561-574.PubMedCrossRef
4.
Zurück zum Zitat Hellstrom K, Fellenius J, Ost LG. One versus five sessions of applied tension in the treatment of blood phobia. Behav Res Ther. 1996; 34: 101-112.PubMedCrossRef Hellstrom K, Fellenius J, Ost LG. One versus five sessions of applied tension in the treatment of blood phobia. Behav Res Ther. 1996; 34: 101-112.PubMedCrossRef
5.
Zurück zum Zitat Foulds J, Wiedmann K, Patterson J, Brooks N. The effects of muscle tension on cerebral circulation in blood-phobic and non-phobic subjects. Behav Res Ther. 1990; 28: 481-486.PubMedCrossRef Foulds J, Wiedmann K, Patterson J, Brooks N. The effects of muscle tension on cerebral circulation in blood-phobic and non-phobic subjects. Behav Res Ther. 1990; 28: 481-486.PubMedCrossRef
6.
Zurück zum Zitat Vogele C, Coles J, Wardle J, Steptoe A. Psychophysiologic effects of applied tension on the emotional fainting response to blood and injury. Behav Res Ther. 2003; 41: 139-155.PubMedCrossRef Vogele C, Coles J, Wardle J, Steptoe A. Psychophysiologic effects of applied tension on the emotional fainting response to blood and injury. Behav Res Ther. 2003; 41: 139-155.PubMedCrossRef
7.
Zurück zum Zitat France CR, France JL, Patterson SM. Blood pressure and cerebral oxygenation responses to skeletal muscle tension: a comparison of two physical maneuvers to prevent vasovagal reactions. Clin Physiol Funct Imaging. 2006; 26: 21-25.PubMedCrossRef France CR, France JL, Patterson SM. Blood pressure and cerebral oxygenation responses to skeletal muscle tension: a comparison of two physical maneuvers to prevent vasovagal reactions. Clin Physiol Funct Imaging. 2006; 26: 21-25.PubMedCrossRef
8.
Zurück zum Zitat Ditto B, Wilkins JA, France CR, Lavoie P, Adler PS. On-site training in applied muscle tension to reduce vasovagal reactions to blood donation. J Behav Med. 2003; 26: 53-65.PubMedCrossRef Ditto B, Wilkins JA, France CR, Lavoie P, Adler PS. On-site training in applied muscle tension to reduce vasovagal reactions to blood donation. J Behav Med. 2003; 26: 53-65.PubMedCrossRef
9.
Zurück zum Zitat Ditto B, France CR, Lavoie P, Roussos M, Adler PS. Reducing reactions to blood donation with applied muscle tension: a randomized controlled trial. Transfusion. 2003; 43: 1269-1275.PubMedCrossRef Ditto B, France CR, Lavoie P, Roussos M, Adler PS. Reducing reactions to blood donation with applied muscle tension: a randomized controlled trial. Transfusion. 2003; 43: 1269-1275.PubMedCrossRef
10.
Zurück zum Zitat Ditto B, France CR. The effects of applied tension on symptoms in French-speaking blood donors: a randomized trial. Health Psychol. 2006; 25: 433-437.PubMedCrossRef Ditto B, France CR. The effects of applied tension on symptoms in French-speaking blood donors: a randomized trial. Health Psychol. 2006; 25: 433-437.PubMedCrossRef
11.
Zurück zum Zitat Ditto B, France CR, Albert M, Byrne N. Dismantling applied tension: mechanisms of a treatment to reduce blood donation-related symptoms. Transfusion. 2007; 47: 2217-2222.PubMedCrossRef Ditto B, France CR, Albert M, Byrne N. Dismantling applied tension: mechanisms of a treatment to reduce blood donation-related symptoms. Transfusion. 2007; 47: 2217-2222.PubMedCrossRef
12.
Zurück zum Zitat Ferguson E, France CR, Abraham C, Ditto B, Sheeran P. Improving blood donor recruitment and retention: Integrating theoretical advances from the social and behavioral science agendas. Transfusion. 2007; 47: 1999-2019.PubMedCrossRef Ferguson E, France CR, Abraham C, Ditto B, Sheeran P. Improving blood donor recruitment and retention: Integrating theoretical advances from the social and behavioral science agendas. Transfusion. 2007; 47: 1999-2019.PubMedCrossRef
13.
Zurück zum Zitat Hupfer ME, Taylor DW, Letwin JA. Understanding Canadian student motivations and beliefs about giving blood. Transfusion. 2005; 45: 149-161.PubMedCrossRef Hupfer ME, Taylor DW, Letwin JA. Understanding Canadian student motivations and beliefs about giving blood. Transfusion. 2005; 45: 149-161.PubMedCrossRef
14.
Zurück zum Zitat Gillespie TW, Hillyer CD. Blood donors and factors impacting the blood donation decision. Transfus Med Rev. 2002; 16: 115-130.PubMedCrossRef Gillespie TW, Hillyer CD. Blood donors and factors impacting the blood donation decision. Transfus Med Rev. 2002; 16: 115-130.PubMedCrossRef
15.
Zurück zum Zitat Piliavin JA. Why do they give the gift of life? A review of research on blood donors since 1977. Transfusion. 1990; 30: 444-459.PubMedCrossRef Piliavin JA. Why do they give the gift of life? A review of research on blood donors since 1977. Transfusion. 1990; 30: 444-459.PubMedCrossRef
16.
Zurück zum Zitat Graham DT. Prediction of fainting in blood donors. Circulation. 1961; 23: 901-906.PubMed Graham DT. Prediction of fainting in blood donors. Circulation. 1961; 23: 901-906.PubMed
17.
Zurück zum Zitat Callahan R, Edelman EB, Smith MS, Smith JJ. Study of the incidence and characteristics of blood donor "reactors". Transfusion. 1963; 3: 76-82.PubMedCrossRef Callahan R, Edelman EB, Smith MS, Smith JJ. Study of the incidence and characteristics of blood donor "reactors". Transfusion. 1963; 3: 76-82.PubMedCrossRef
18.
Zurück zum Zitat Ditto B, France CR. Vasovagal symptoms mediate the relationship between predonation anxiety and subsequent blood donation in female volunteers. Transfusion. 2006; 46: 1006-1010.PubMedCrossRef Ditto B, France CR. Vasovagal symptoms mediate the relationship between predonation anxiety and subsequent blood donation in female volunteers. Transfusion. 2006; 46: 1006-1010.PubMedCrossRef
19.
Zurück zum Zitat Meade MA, France CR, Peterson LM. Predicting vasovagal reactions in volunteer blood donors. J Psychosom Res. 1996; 40: 495-501.PubMedCrossRef Meade MA, France CR, Peterson LM. Predicting vasovagal reactions in volunteer blood donors. J Psychosom Res. 1996; 40: 495-501.PubMedCrossRef
20.
Zurück zum Zitat Wiltbank TB, Giordano GF, Kamel H, Tomasulo P, Custer B. Faint and prefaint reactions in whole-blood donors: An analysis of predonation measurements and their predictive value. Transfusion. 2008; 48: 1799-1808.PubMedCrossRef Wiltbank TB, Giordano GF, Kamel H, Tomasulo P, Custer B. Faint and prefaint reactions in whole-blood donors: An analysis of predonation measurements and their predictive value. Transfusion. 2008; 48: 1799-1808.PubMedCrossRef
21.
Zurück zum Zitat Thomson RA, Bethel J, Lo AY, Ownby HE, Nass CC, Williams AE. Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study. Transfusion. 1998; 38: 359-367. Thomson RA, Bethel J, Lo AY, Ownby HE, Nass CC, Williams AE. Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study. Transfusion. 1998; 38: 359-367.
22.
Zurück zum Zitat France CR, France JL, Roussos M, Ditto B. Mild reactions to blood donation predict a decreased likelihood of donor return. Transfus Apheresis Sci. 2004; 30: 17-22.CrossRef France CR, France JL, Roussos M, Ditto B. Mild reactions to blood donation predict a decreased likelihood of donor return. Transfus Apheresis Sci. 2004; 30: 17-22.CrossRef
23.
Zurück zum Zitat France CR, Rader A, Carlson B. Donors who react may not come back: analysis of repeat donation as a function of phlebotomist ratings of vasovagal reactions. Transfus Apher Sci. 2005; 33: 99-106.PubMedCrossRef France CR, Rader A, Carlson B. Donors who react may not come back: analysis of repeat donation as a function of phlebotomist ratings of vasovagal reactions. Transfus Apher Sci. 2005; 33: 99-106.PubMedCrossRef
24.
Zurück zum Zitat Newman BH, Newman DT, Ahmad R, Roth AJ. The effect of whole-blood donor adverse events on blood donor return rates. Transfusion. 2006; 46: 1374-1379.PubMedCrossRef Newman BH, Newman DT, Ahmad R, Roth AJ. The effect of whole-blood donor adverse events on blood donor return rates. Transfusion. 2006; 46: 1374-1379.PubMedCrossRef
25.
Zurück zum Zitat Germain M, Glynn SA, Schreiber GB, et al. Determinants of return behavior: A comparison of current and lapsed donors. Transfusion. 2007; 47: 1862-1870.PubMedCrossRef Germain M, Glynn SA, Schreiber GB, et al. Determinants of return behavior: A comparison of current and lapsed donors. Transfusion. 2007; 47: 1862-1870.PubMedCrossRef
26.
Zurück zum Zitat Janetzko K, Kluter H, Kirchner H, Klotz KF. The effect of moderate hypovolaemia on microcirculation in healthy older blood donors. Anaesthesia. 2001; 56: 103-107.PubMedCrossRef Janetzko K, Kluter H, Kirchner H, Klotz KF. The effect of moderate hypovolaemia on microcirculation in healthy older blood donors. Anaesthesia. 2001; 56: 103-107.PubMedCrossRef
27.
Zurück zum Zitat Martin CE, Shaver JA, Leon DF, Thompson ME, Reddy PS, Leonard JJ. Autonomic mechanisms in hemodynamic responses to isometric exercise. J Clin Invest. 1974; 54: 104-115.PubMedCrossRef Martin CE, Shaver JA, Leon DF, Thompson ME, Reddy PS, Leonard JJ. Autonomic mechanisms in hemodynamic responses to isometric exercise. J Clin Invest. 1974; 54: 104-115.PubMedCrossRef
28.
Zurück zum Zitat Freyschuss U. Cardiovascular adjustment to somatomotor activation. The elicitation of increments in heart rate, aortic pressure and venomotor tone with the initiation of muscle contraction. Acta Physiol Scand Suppl 1970; 342: 1-63.PubMed Freyschuss U. Cardiovascular adjustment to somatomotor activation. The elicitation of increments in heart rate, aortic pressure and venomotor tone with the initiation of muscle contraction. Acta Physiol Scand Suppl 1970; 342: 1-63.PubMed
29.
Zurück zum Zitat Taylor JA, Hayano J, Seals DR. Lesser vagal withdrawal during isometric exercise with age. J Appl Physiol. 1995; 79: 805-811.PubMed Taylor JA, Hayano J, Seals DR. Lesser vagal withdrawal during isometric exercise with age. J Appl Physiol. 1995; 79: 805-811.PubMed
30.
Zurück zum Zitat Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Management of vasovagal syncope: Controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002; 106: 1684-1689.PubMedCrossRef Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Management of vasovagal syncope: Controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002; 106: 1684-1689.PubMedCrossRef
31.
Zurück zum Zitat Krediet CT, de Bruin IG, Ganzeboom KS, Linzer M, van Lieshout JJ, Wieling W. Leg crossing, muscle tensing, squatting, and the crash position are effective against vasovagal reactions solely through increases in cardiac output. J Appl Physiol. 2005; 99: 1697-1703.PubMedCrossRef Krediet CT, de Bruin IG, Ganzeboom KS, Linzer M, van Lieshout JJ, Wieling W. Leg crossing, muscle tensing, squatting, and the crash position are effective against vasovagal reactions solely through increases in cardiac output. J Appl Physiol. 2005; 99: 1697-1703.PubMedCrossRef
32.
Zurück zum Zitat Burgess HJ, Penev PD, Schneider R, Van Cauter E. Estimating cardiac autonomic activity during sleep: impedance cardiography, spectral analysis, and Poincare plots. Clin Neurophysiol. 2004; 115: 19-28.PubMedCrossRef Burgess HJ, Penev PD, Schneider R, Van Cauter E. Estimating cardiac autonomic activity during sleep: impedance cardiography, spectral analysis, and Poincare plots. Clin Neurophysiol. 2004; 115: 19-28.PubMedCrossRef
33.
Zurück zum Zitat Newlin DB, Levenson RW. Pre-ejection period: Measuring beta-adrenergic influences upon the heart. Psychophysiology. 1979; 16: 546-553.PubMedCrossRef Newlin DB, Levenson RW. Pre-ejection period: Measuring beta-adrenergic influences upon the heart. Psychophysiology. 1979; 16: 546-553.PubMedCrossRef
34.
Zurück zum Zitat Spielberger C, Gorsuch R, Lushene R. State-Trait Anxiety Inventory Manual. Palo Alto: Consulting Psychologists Press; 1970. Spielberger C, Gorsuch R, Lushene R. State-Trait Anxiety Inventory Manual. Palo Alto: Consulting Psychologists Press; 1970.
35.
Zurück zum Zitat Task.Force. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043–65. Task.Force. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043–65.
36.
Zurück zum Zitat Grossman P, Taylor EW. Toward understanding respiratory sinus arrhythmia: relations to cardiac vagal tone, evolution and biobehavioral functions. Biol Psychol. 2007; 74: 263-285.PubMedCrossRef Grossman P, Taylor EW. Toward understanding respiratory sinus arrhythmia: relations to cardiac vagal tone, evolution and biobehavioral functions. Biol Psychol. 2007; 74: 263-285.PubMedCrossRef
37.
Zurück zum Zitat Thayer JF, Sollers JJ, Ruiz-Padial E, Vila J. Estimating respiratory frequency from autoregressive spectral analysis of heart period. IEEE Eng Med Biol Mag. 2002; 21: 41-45.PubMedCrossRef Thayer JF, Sollers JJ, Ruiz-Padial E, Vila J. Estimating respiratory frequency from autoregressive spectral analysis of heart period. IEEE Eng Med Biol Mag. 2002; 21: 41-45.PubMedCrossRef
38.
Zurück zum Zitat Sherwood A, Allen MT, Fahrenberg J, Kelsey RM, Lovallo WR, van Doornen LJ. Methodological guidelines for impedance cardiography. Psychophysiology. 1990; 27: 1-23.PubMedCrossRef Sherwood A, Allen MT, Fahrenberg J, Kelsey RM, Lovallo WR, van Doornen LJ. Methodological guidelines for impedance cardiography. Psychophysiology. 1990; 27: 1-23.PubMedCrossRef
39.
Zurück zum Zitat Salomon K, Matthews KA, Allen MT. Patterns of sympathetic and parasympathetic reactivity in a sample of children and adolescents. Psychophysiology. 2000; 37: 842-849.PubMedCrossRef Salomon K, Matthews KA, Allen MT. Patterns of sympathetic and parasympathetic reactivity in a sample of children and adolescents. Psychophysiology. 2000; 37: 842-849.PubMedCrossRef
40.
Zurück zum Zitat Donadio V, Liguori R, Elam M, et al. Arousal elicits exaggerated inhibition of sympathetic nerve activity in phobic syncope patients. Brain. 2007; 130: 1653-1662.PubMedCrossRef Donadio V, Liguori R, Elam M, et al. Arousal elicits exaggerated inhibition of sympathetic nerve activity in phobic syncope patients. Brain. 2007; 130: 1653-1662.PubMedCrossRef
41.
Zurück zum Zitat Ziegler MG, Echon C, Wilner KD, Specho P, Lake CR, McCutchen JA. Sympathetic nervous withdrawal in the vasodepressor (vasovagal) reaction. J Auton Nerv Syst. 1986; 17: 273-278.PubMedCrossRef Ziegler MG, Echon C, Wilner KD, Specho P, Lake CR, McCutchen JA. Sympathetic nervous withdrawal in the vasodepressor (vasovagal) reaction. J Auton Nerv Syst. 1986; 17: 273-278.PubMedCrossRef
42.
Zurück zum Zitat Wallin BG, Sundlof G. Sympathetic outflow to muscles during vasovagal syncope. J Auton Nerv Syst. 1982; 6: 287-291.PubMedCrossRef Wallin BG, Sundlof G. Sympathetic outflow to muscles during vasovagal syncope. J Auton Nerv Syst. 1982; 6: 287-291.PubMedCrossRef
43.
Zurück zum Zitat Gerlach AL, Spellmeyer G, Vogele C, et al. Blood-injury phobia with and without a history of fainting: disgust sensitivity does not explain the fainting response. Psychosom Med. 2006; 68: 331-339.PubMedCrossRef Gerlach AL, Spellmeyer G, Vogele C, et al. Blood-injury phobia with and without a history of fainting: disgust sensitivity does not explain the fainting response. Psychosom Med. 2006; 68: 331-339.PubMedCrossRef
44.
Zurück zum Zitat Sarlo M, Buodo G, Munafo M, Stegagno L, Palomba D. Cardiovascular dynamics in blood phobia: evidence for a key role of sympathetic activity in vulnerability to syncope. Psychophysiology. 2008; 45: 1038-1045.PubMedCrossRef Sarlo M, Buodo G, Munafo M, Stegagno L, Palomba D. Cardiovascular dynamics in blood phobia: evidence for a key role of sympathetic activity in vulnerability to syncope. Psychophysiology. 2008; 45: 1038-1045.PubMedCrossRef
45.
Zurück zum Zitat Engel GL. Psychologic stress, vasodepressor (vasovagal) syncope, and sudden death. Ann Intern Med. 1978; 89: 403-412.PubMed Engel GL. Psychologic stress, vasodepressor (vasovagal) syncope, and sudden death. Ann Intern Med. 1978; 89: 403-412.PubMed
46.
Zurück zum Zitat van Lieshout JJ, Wieling W, Karemaker JM, Eckberg DL. The vasovagal response. Clin Sci. 1991; 81: 575-586.PubMed van Lieshout JJ, Wieling W, Karemaker JM, Eckberg DL. The vasovagal response. Clin Sci. 1991; 81: 575-586.PubMed
47.
Zurück zum Zitat Bracha HS. Freeze, flight, fight, fright, faint: adaptationist perspectives on the acute stress response spectrum. CNS Spectr. 2004; 9: 679-685.PubMed Bracha HS. Freeze, flight, fight, fright, faint: adaptationist perspectives on the acute stress response spectrum. CNS Spectr. 2004; 9: 679-685.PubMed
48.
Metadaten
Titel
Physiological Correlates of Applied Tension May Contribute to Reduced Fainting During Medical Procedures
verfasst von
Blaine Ditto, Ph.D.
Nelson Byrne, Ph.D.
Crystal Holly, B.Sc.
Publikationsdatum
01.06.2009
Verlag
Springer-Verlag
Erschienen in
Annals of Behavioral Medicine / Ausgabe 3/2009
Print ISSN: 0883-6612
Elektronische ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-009-9114-7

Weitere Artikel der Ausgabe 3/2009

Annals of Behavioral Medicine 3/2009 Zur Ausgabe

Neu in den Fachgebieten Neurologie und Psychiatrie

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.