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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINEVolume 9, Number 3, 2003, pp. 355–369© Mary Ann Liebert, Inc.
Impact of a Workplace Stress Reduction Program onBlood Pressure and Emotional Healthin Hypertensive Employees
ROLLIN M
C
CRATY, Ph.D., MIKE ATKINSON, and DANA TOMASINO, B.A.
ABSTRACTObjectives:
This study examined the impact of a workplace-based stress management pro-gram on blood pressure (BP), emotional health, and workplace-related measures in hyperten-sive employees of a global information technology company.
Design:
Thirty-eight (38) employees with hypertension were randomly assigned to a treatmentgroup that received the stress-reduction intervention or a waiting control group that received nointervention during the study period. The treatment group participated in a 16-hour program,which included instruction in positive emotion refocusing and emotional restructuring techniquesintended to reduce sympathetic nervous system arousal, stress, and negative affect, increase pos-itive affect, and improve performance. Learning and practice of the techniques was enhanced byheart rate variability feedback, which helped participants learn to self-generate
 physiological co-herence
, a beneficial physiologic mode associated with increased heart rhythm coherence, physi-ologic entrainment, parasympathetic activity, and vascular resonance. BP, emotional health, andworkplace-related measures were assessed before and 3 months after the program.
Results:
Three months post-intervention, the treatment group exhibited a mean adjusted re-duction of 10.6 mm Hg in systolic BP and of 6.3 mm Hg in diastolic BP. The reduction in sys-tolic BP was significant in relation to the control group. The treatment group also demonstratedimprovements in emotional health, including significant reductions in stress symptoms, de-pression, and global psychological distress and significant increases in peacefulness and posi-tive outlook. Reduced systolic BP was correlated with reduced stress symptoms. Furthermore,the trained employees demonstrated significant increases in the work-related scales of work-place satisfaction and value of contribution.
Conclusions:
Results suggest that a brief workplace stress management intervention can pro-duce clinically significant reductions in BP and improve emotional health among hypertensiveemployees. Implications are that such interventions may produce a healthier and more produc-tive workforce, enhancing performance and reducing losses to the organization resulting fromcognitive decline, illness, and premature mortality.
355
HeartMath Research Center, Institute of HeartMath, Boulder Creek, CA.
INTRODUCTION
H
ypertension is considered one of the mostprominent public health issues faced bythe world today. In the United States alone, itaffects approximately 50 million people, or 1 in4 adults (National Heart, Lung, and Blood In-stitute, 1997), and current trends suggest that
 
the number of adults diagnosed with high blood pressure (BP) is increasing (Ayala et al.,2002). High BP is a major risk factor for deathand disability related to coronary heart disease,heart attacks, strokes, kidney disease, and vas-cular complications (National Heart, Lung, andBlood Institute, 1997). In addition, high systolicBP has been linked with decreased cognitiveperformance, memory loss, and the loss ofhealthy brain tissue (Launer et al., 1995; Swanet al., 1998). Conversely, reducing BP in hy-pertensive individuals has been found to re-duce the risk of death and disability signifi-cantly, and is therefore a critically importantfactor in employee health (Hypertension De-tection and Follow-up Program CooperativeGroup, 1979; Launer et al., 1995; MacMahon etal., 1990; Thijs et al., 1992).There is considerable evidence to suggest thathigh BP is linked to persistent stress and the wayin which people cope (Henry et al., 1986; Linden,1984; Markovitz et al., 1993; Shapiro, 1996; Step-toe, 1986). Chronic psychological stress is asso-ciated with increased activation of the sym-pathetic-adrenomedullary axis and increasedcirculating levels of adrenaline and noradrena-line. Chronically elevated adrenaline levels have been implicated in the development and pro-gression of hypertension (Julius et al., 1988; Ru-mantir et al., 2000; Schalekamp et al., 1983), andhypertensive subjects have been demonstratedto have increased sympathetic and reducedparasympathetic tone compared to healthy con-trols (Guzzetti et al., 1988; Langewitz et al., 1994).Conversely, behavioral interventions that reducestress and sympathetic arousal have been shownto be effective nonpharmacologic treatments forhypertension; such treatments have been associ-ated with clinically significant and sustainableBP reductions as well as lowered health carecosts (Charlesworth et al., 1984; Chesney et al.,1987; Linden and Chambers, 1994; Mathias, 1991;Ward et al., 1987; Weiss, 1988).In addition to being implicated in the de-velopment and aggravation of hypertensionand other health problems, employee stressand emotional well-being have also beenidentified as important determinants of orga-nizational health, performance, and produc-tivity. For example, high levels of emotionaldistress have been found to be among themost costly health problems to employers interms of absenteeism, disability, and failureto meet productivity standards (Burton et al.,1999). Depression, a common problem amongworkers, costs the United States $44 billionper year in lost productivity, according to aNational Foundation for Brain Research sur-vey of human resource professionals con-ducted in 1999. Another nationwide surveyconducted by the New York Business Groupon Health revealed that each employee suf-fering from stress, anxiety, or depression isestimated to lose 16 days of work per yearcompared to an average of 4–6 lost workdaysfor all employees. Additionally, in a recent 3-year analysis of more than 46,000 workersfrom six major companies, depression andunmanaged stress emerged as the top twomost costly risk factors in terms of medicalexpenditures—increasing health care costs by2–7 times as much as physical risk factorssuch as smoking, obesity, and poor exercisehabits. In this study, combined psychosocialproblems, including stress and depression,led to costs nearly 2.5 times higher than thoseof workers who did not report these concerns(Goetzel et al., 1998).In contrast, studies conducted across a broadrange of settings have linked positive emotionand psychological well-being to numerous or-ganizationally relevant benefits, including re-duced absenteeism (Iverson et al., 1998), in-creased cognitive flexibility and innovativeproblem solving (Ashby et al., 1999; Isen,1998), and improved negotiation style(Carnevale and Isen, 1986), creativity (Isen,1998; Isen et al., 1987), decision-making (Isen,2000), job performance (Staw and Barsade,1993; Wright and Staw, 1999), job achievement(Staw et al., 1994), and job satisfaction (Wood-ward and Chen, 1994). The growing body ofresearch demonstrating the favorable impactof positive emotions on performance andhealth (Blakeslee, 1997; Danner et al., 2001; Sa-lovey et al., 2000) has recently fueled an inter-est in developing and implementing interven-tions that cultivate positive emotions in theworkplace (Childre and Cryer, 2000; Cooper-rider and Whitney, 2000; Fredrickson, 2000b)
M
C
CRATY ET AL.356
 
and in daily life (Fredrickson, 2000a; McCratyand Childre, 2003; Seligman and Csikszentmi-halyi, 2000).The purpose of this study was to determineif a positive emotion-focused stress manage-ment program known as Inner Quality Man-agement
®
(IQM; Institute of HeartMath, Boul-der Creek, CA) could reduce BP and improveemotional health in known hypertensive em-ployees. The IQM program teaches individualsa number of practical self-management tech-niques designed to reduce stress and negativeaffect, increase positive affect, enhance health,and improve business performance (Childreand Cryer, 2000). Previous studies have demon-strated that the IQM techniques favorably im-pact physiologic balance by reducing sympa-thetic arousal, increasing parasympatheticactivity (McCraty et al., 1995; Tiller et al., 1996),reducing cortisol levels, increasing dehydro-epiandrosterone (DHEA) (McCraty et al.,1998), and enhancing immune system activity(McCraty et al., 1996; Rein et al., 1995). Thesetechniques have also been shown to impactorganizationally relevant outcomes, such asimproving cognitive performance (McCraty,2002b; McCraty and Atkinson, 2004), produc-tivity, communication, and job satisfaction andreducing employee turnover (Barrios-Choplinet al., 1997, 1999; Childre and Cryer, 2000).In addition, practice of the IQM techniqueshas been demonstrated to improve health sta-tus in a number of clinical populations (Mc-Craty et al., 2004), including individuals withcongestive heart failure (Luskin et al., 2002),diabetes (McCraty et al., 2000), and acquiredimmune deficiency syndrome (AIDS) (Roz-man et al., 1996). In particular, a number of pi-lot studies conducted at Motorola, Shell, andBritish Petroleum have demonstrated that ex-ecutives with stage 1 and stage 2 hypertensionwho participated in an IQM training programwere able to restore their BP to normal valueswithout the aid of medication after practicingthe IQM techniques (Barrios-Choplin et al.,1997; McCraty et al., 2001; A.D. Watkins*).However, these pilot studies were uncon-trolled for BP outcomes, and the subject pop-ulations included only a small number of hy-pertensive employees.In the present study, the impact of the IQMprogram was investigated specifically in agroup of hypertensive individuals, using a ran-domized controlled trial design. Psychologicaland work performance-related parameters wereassessed concurrently with BP changes to de-termine the overall impact of the program onemployees’ emotional health and workplace ef-fectiveness.
METHOD
Eligibility, recruitment, and attrition
The target population consisted of male andfemale hypertensive employees of a global in-formation technology company. Initial BP eli-gibility criteria required that each participanthad been diagnosed with hypertension byhis/her primary care physician. Participantseither must have been taking antihypertensivemedication on a regular schedule, or musthave had at least 1 of the 4 baseline BP read-ings (average of 3 successive measurements) inthe range of 90–105 mm Hg diastolic or 140–179mm Hg systolic.Over a 4-week period, 50 individuals re-cruited from a site-wide e-mail announcementwere screened for eligibility for the program.Of these, 38 were included in the study andrandomly assigned to either a treatmentgroup, which received the IQM training, or awaiting control group, which received no in-tervention during the study period but re-ceived the IQM training once the study wascompleted. The most common reason for ex-clusion of candidates during the baseline pe-riod was for schedule conflicts or, less com-monly, personal reasons. Of the 38 participants,6 were excluded from the analysis during the3-month study period. The reasons for exclu-sion were because of changes in antihyperten-sive medications prescribed by the partici-pant’s physician (2 treatment group and 2control group participants) or because the par-ticipant began a vigorous exercise programshortly after the baseline measurement period
STRESS REDUCTION FOR HYPERTENSION357
*Unpublished work from 1998 and 1999.
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