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Presented to the Graduate Council of the

University of North Texas in Partial

Fulfillment of the Requirements

For the Degree of



Jeffrey T. Baldridge, B.A., M.A.

Denton, Texas May, 1992 37?

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Presented to the Graduate Council of the University of North Texas in Partial Fulfillment of the Requirements For the Degree of


By Jeffrey T. Baldridge, B.A., M.A.

Denton, Texas May, 1992 Baldridge, Jeffrey T. Imagery. Psychotherapy and Directed Relaxation: Physiological Correlates. Doctor of Philosophy (Clinical Psychology), May, 1992, 110 pp., 11 tables, references, 95 titles.

Thirty outpatients being treated at Wilford Hall USAF Medical Center Department of Behavioral Health Psychology were randomly assigned to either a relaxation/imagery training class (R/I), a short-term psychotherapy group (P/G) or a no treatment control group. Subjects had psychological, physiological and immunological data taken before and after treatment. Results indicated that support for the hypothesis that relaxation/imagery training improves the psychological, physiological, and immunological functioning of participants was found. R/I participants exhibited decreased diastolic blood pressure, felt less fatigue and tension, reported decreased severity of symptoms, and exhibited an improved potential for immune response. This same support was not found for psychotherapy group participants. P/G subjects showed a tendency to exhibit increased diastolic blood pressure after treatment sessions, did not exhibit any significant psychological changes as measured by the POMS and SRRS, and exhibited some symptoms of immunosuppression and possibly the beginnings of infection.






METHOD 17 Subj

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9. Summary of Means and Standard Deviations for Helper/Suppressor Ratios Pre and Post Treatment (Absolute CD4/CD8x(10 3 ) )

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A number of studies have recently focused on the interaction patterns of the nervous system, the endocrine system and the immune system. This area of study has been termed "psychoneuroimmunology" (Ader, 1981). Evidence suggests that the immune system and the central nervous system "communicate" and affect each other through a variety of hormones, neuropeptides, and growth factors (e.g.

Bonneau, Keicolt-Glaser, & Glaser, 1990). Support for the idea that the CNS and the immune system communicate and influence one another comes from research which has examined the effects of stress and major life changes on the immune system, as well as the effects of relaxation/imagery, and psychotherapy on these systems.

Stress and its Various Effects Stress has been defined by Selye (1980) as the "nonspecific" way in which a body reacted to any demand.

Selye described a three stage process which outlines the body's pattern of adjustment to stressors which he termed the General Adaptation Syndrome or GAS. The first stage of the syndrome called an Alarm reaction occured when an individual encountered stimuli to which he or she has not adapted. Objective signs of the reaction included 1 2 tachycardia, loss of muscle tone, and decreased blood pressure. Selye reported that these changes were immediately followed by a reversal of these changes so that the individual would be mobilized for action during which increased blood pressure, increased heart rate, dry mouth, decreased blood flow to the extremities, and piloerection were experienced by the individual. Wilson and Schneider (1980) showed that this fight or flight response involved over 1,400 physiological and chemical changes. This alarm reaction typically involved the sympathetic nervous system and the secretion of adrenalin and noradrenalin from the adrenal glands. This prepared the individual for defensive or coping action.

Stage two of the GAS was termed Resistance. During this stage the body adapted to the stressor, and the physiological symptoms were reduced or are no longer apparent. This adjustment required and continues to require energy to maintain a semblance of homeostasis in the face of the stressor. The adjustment also decreased available resources for coping and adjusting to other stressors in the environment. During the course of this adaptation, Selye added that the physiological changes could lead to "diseases of adaptation" which included ulcers and hypertension.

Achterberg (1985) stated that during periods of chronic stress the body tends to secrete corticosteroids which

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ranging effects on the cardiovascular system as well and kidney function. Selye's third stage of the GAS was termed Exhaustion. During this phase the body's finite store of energy had been used up, and it was no longer able to adapt to current stressors. Exhaustion was characterized by the inability of the pituitary and adrenal cortex to secrete further hormones (Sutrer, 1986). If the organism was subject to further stress death occured The belief that the hypothalamus controls the autonomic nervous system and thus has wide ranging effects on the body has received considerable scientific attention. The hypothalamus is connected to the pituitary gland through chemical as well as neurological pathways (Kolb and Whishaw, 1986). This connection has been termed the hypothalamuspituitary-adrenocortical axis. Under stress, the pituitary secretes adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal cortex to secrete corticosteroids.

One of these types of steroids are the mineralcorticoids.

This class of steroids act to enhance inflammation by encouraging the loss of potassium through the kidneys. This causes fluid retention which may lead to kidney damage as well as high blood pressure and impaired cardiac functioning (Sutrer, 1986). Glucosteroids have been shown to decrease inflammation, and an increase in blood glucose levels (Sutrer, 1986).

Stress and the Immune System The current support for the idea that the central nervous system mediates the effects of stress has been grouped under the name of a new field termed psychoneuroimmunology. Schleifer, Keller, and Stein (1985) documented a decreased white blood cell production after such stressors as sleep deprivation, marathon running, and space flight. Holmes and Rahe (1967) developed a Social Readjustment Rating Scale on which high scorers (an indication high stress levels) were found to have an extremely high risk of major illness within a two year period. Jacobs et al., (1970) also found that individuals who reported high numbers of stressful life events were more likely to be diagnosed with diseases, and took longer to recover from them.

Bassen (1977) has reviewed a number of studies which show that high levels of corticosteroids interrupt normal immune functioning in humans. He showed that there is a negative correlation between blood levels of Cortisol and blood concentrations of lymphocytes. Administrations of corticosteroids were followed by abrupt decreases in lymphocytes, and a slow return within 24 hours. Bassen (1977) also found that skin test reactions to various antigens were decreased following administrations of corticosteroids. Keicolt-Glaser et al. (1984) found

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who had experienced significant life changes during the past year.

Imagery and its Effects According to Achterberg (1985) imagery is a thought process which utilizes both the sensory and motor faculties of the brain. Imagery processes occur in such phenomenon as hypnosis, placebo effects, biofeedback, systematic desensitization, psychotherapy, memory, and fantasy. The physiological correlates of these images are significant and varied.

Luria (1968) documented a reported eideticker who was able to alter his pupil size, heart rate and cochlear reflex by imagining himself participating in certain activities.

Barber et al. (1964) found that salivation was increased when subjects visualized eating a lemon, and White (1978) found similar results when subjects were simply asked to imagine an increased salivary flow. Weerts and Roberts (1976) found that highly charged emotional stimuli produced significantly higher blood pressure and heart rate when compared with more neutral stimuli.

Sutherland and Harrell (1986) conducted a unigue study with fearful, racially noxious and neutral stimuli.

Subjects were trained to image certain stimuli on cue during relaxation training. When the stimuli were imaged it was found that the racially noxious and fearful stimuli elicited

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did the neutral stimuli. Results also suggested that subjects who scored higher on measures of trait anxiety and Type A behavior patterns also tended to show a higher level of physiological reactivity to negative imagery.

Feher et al. (1989) conducted a study with mothers of premature infants. The authors reported that it was common for mothers of these infants to be unable to express milk because of the stress, and anxiety of their circumstances. Mothers were asked to listen to a short audiotape which included relaxation and imagery techniques.

After only one exposure to the tape mothers expressed 63% more milk than a group of control mothers. Mothers of low birth weight infants who received mechanical ventilation increased their volume by 121%.

Keicolt-Glaser et al. (1986) contrasted medical students who were either assigned to a relaxation training group, or to a no treatment group. The groups were monitored before and during their midterm exams. During the exam period results indicated decreases in helper-inducer lymphocyte percentages, natural killer cell activity, and helper-inducer/suppressor-cytotoxic cell ratios. The authors found that frequency of relaxation practice was positively related to helper-inducer cell percentage. The authors also studied a geriatric population and found subjects who were assigned to a triweekly relaxation group

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activity, as well as decreases in antibody titers to herpes simplex virus. These subjects were compared to both a support intervention and a no treatment group, both of which showed no change.

Ryder and Achterberg (1989) performed a study in which they examined the effects of specific cell imagery. Two groups were trained in imagery techniques, and progressive muscle relaxation. One group focused on neutrophil specific imagery (morphology, location, movement) and the other on lymphocyte imagery. Results indicated that both groups showed significant changes in only the cell types that were imaged. Subjects did however show decreases in those cell percentages. The authors noted this may have been due to increased cell activation, and movement outside of the vasculature.

Achterberg (1984) reviewed her research with cancer patients and the associations between personality variables, blood chemistry, hematological factors and disease status two months after the data were collected. The author found that the only predictive variables were subject scores on measures of denial, locus of control, investment in self, and a combined measure of imagery vividness, symbolism, frequency of positive images, and perceived effectiveness of treatment. Of all the predictive variables, the combined image variable was most effective with a reported 93%

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for patients who were dead or severely deteriorated at follow up. Achterberg also found that when patients imagined their cancer cells as dangerous, predatory, or impregnable the disease tended to spread, while those who saw the cells as weak and vulnerable tended to recover more often. Schneider, Smith and Whitcher (1983) also found significant correlations between imagery and white blood cell activity and number using similar imagery variables in healthy subjects. Crawford (1985) found significant increases in T-cell activity and number after a relaxation and imagery process. Hall, Longo and Dixon (1981) conducted a study in which hypnotized subjects were asked to image an increase in the number of white blood cells in their blood.

Results showed that younger subjects showed a significant increase in their white blood cell count. The experimenters also found that subjects who scored higher on a measure of hypnotizability exhibited an elevated white blood cell count one hour after the imagery procedure while other subjects did not.

Relaxation and its Effects Benson (1975) documented the physiological effects of assuming a comfortable position, ignoring distracting thoughts, closing the eyes, and the use of repetitive mental actions. Benson found that these activities elicited a relaxation response which included decreased oxygen

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respiration rate, as well as a decreased blood lactate level. Hoffman et al. (1982) studied the effects of stress on subjects who had been Eliciting the relaxation response over a one month period, and compared them to subjects who had only been sitting quietly. Results showed that the relaxation response subjects had an increased level of norepinephrine in their blood after stress compared to controls, while physiological measures for both groups were not significantly different. The authors interpreted the results as showing that the relaxation response subjects required more NE to produce the physiological changes common with sympathetic nervous system arousal.

Gloor (1954), in his review of the work of the Swiss physiologist W. R. Hess, made use of the term ergotropic reflex to describe the fight or flight reaction of sympathetic arousal. The opposite reflex was termed trophotropic which described the return of homeostasis.

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