Self-disclosure in biofeedback of hypertension

Thesis (Ph. D.)--University of Washington, 1991The purpose of this study was to examine subject self-disclosure as a variable which heightens the value of biofeedback, impacts psychophysiologic arousal, and influences the therapeutic relationship between nurse and client.This investigation was a repeated measures design of a drug free hypertension sample. Subjects who demonstrated hypertension entered the treatment phase of the investigation. Subjects were assessed prior to the intervention using multiple measures of cognitive/affective function, as well as psychophysiologic and hemodynamic responses.Subjects (N = 20) received 14 training sessions. Biofeedback sessions were approximately one and one-half hours in duration occurring twice a week for the first month and weekly thereafter. The biofeedback component of the intervention was designed to increase the subject's ability to regulate his/her cardiovascular responses through multi-modal training in heart rate control, alteration of respiratory patterns, and generalized decrease in sympathetic arousal through relaxation training. The self-management/stress counselling component of the intervention utilized a psychoeducational format individualized to the subject and the specific concerns brought to the therapeutic arena.Self-disclosure was measured using a twenty item tool of assessing "sharing" behaviour (adapted from The Patient Self-Disclosure Questionnaire; Dawson, 1985). Modified versions of the tool assessed the clinician's perception of subject's self-disclosure, and subject perception of difficulty of self-disclosure during a particular training session. Convergent validity of the self-disclosure tool was tested with the use of an analog scale.The results of the analysis of the correlation of change in self-disclosure visual analog scale and change scores on the global and subscale dimensions of the SCL-90-R (Derogatis, 1979) and subscales of the symptoms of Stress Inventory (Leckie and Thompson, 1978) demonstrated a significant relationship between increase in self-disclosure and increase in multiple indicators of psychological distress including positive symptom total, hostility, and cognitive disorganization.In addition, this investigation examined the association between change in self-disclosure and change in several indicators of hypertension. Data analysis demonstrated an association between decrease in diastolic blood pressure and systemic vascular resistance and increase in self-disclosure.These study results suggest that the intrapersonal changes associated with self-disclosure in a biofeedback-assisted self-management training are significant. In summary, self-disclosure by clients during biofeedback training increased and was paradoxically associated with decrease in indicators of hypertension and increase in dimensions of psychological distress