HYPERTENSION

 
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HYPERTENSION
What Is Cognitive Behavior Therapy?

Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.

Changes or goals might involve:

  • A way of acting: like smoking less or being more outgoing;
  • A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
  • A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
  • A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.
Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past. They concentrate on a person’s views and beliefs about their life, not on personality traits. Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families. Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.

HOW TO GET HELP: If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet. You may, or may not, find a competent therapist in this manner. It is wise to check on the credentials of a psychotherapist. It is expected that competent therapists hold advanced academic degrees. They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association. Of course, they should be licensed to practice in your state. You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations. You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"

The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition. These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.

Hypertension, or high blood pressure, is a very common condtion. Blood pressure is measured in millimeters of mercury (mm Hg). The systolic pressure (upper number) represents the pressure when the heart is contracting to push the blood through the vesels and the diastolic pressure (lower number) is the pressure when the heart is at rest between contractions. About one in four adult Americans has hypertension, which is diagnosed when diastolic blood pressure is consistently at or above 90 mm Hg or systolic pressure is above 140 mm Hg.

Hypertension typically causes no symptoms until complictions, such as a stroke or heart attack, occur. It is often detected by routine blood pressure checks at clinics or doctors’ offices. It is more common in older people, in African- Americans, in overweight individuals, and in people with relatives who have high blood pressure. High blood pressure can also lead to hypertension; people with high blood pressure may want to keep this under control so that it doesn’t progress to hypertension. The approaches to reducing hypertension are also effective in treating high blood pressure.

It is important to detect and treat hypertension because it is one of the major “risk factors” for heart disease and stroke. Research during the past 25 years has shown that people with hypertension will lower their risk of heart disease and stroke (particularly stroke) and other complications if they reduce their blood pressure. Many medications have been used successfully to reduce blood pressure and risk of complications, but some people experience unwanted side effects from these drugs and newer drugs tend to be more costly. Experts use different drugs, often several in combination, depending on the type and severity of the hypertension. There is some disagreement about exactly at what level treatment should start. Lifestyle modification, including behavioral treatments, have been recommended as the first step of treatment for some patients and as adjunctive therapy for many patients who require medications to control their hypertension.

Life-Style Modification for Hypertension

Life-style modification for hypertension helps people with elevated or high normal blood pressure to reduce weight, increase their physical activity, reduce the amount of alcohol they consume, decrease the amount of salt (sodium chloride) in their diets, and/or manage stress. Smoking cessation, although not directly related to blood pressure control, is also very important for reducing overall cardiovascular disease risk. Physicians, dietitians, and other health professionals should be involved in the prescription of some of these treatments. It is important to note that most of these behavioral changes have no negative side effects and several positive ones.

Behavior therapists are skilled at teaching techniques that have been used by many people to help them succeed in making the behavioral changes that are required.

Weight Reduction

Losing as little as 10 pounds has been enough to reduce or eliminate the need for blood pressure medication in some individuals with hypertension. This is a weight loss goal that many people can achieve. Behavior modification techniques used to assist weight loss include setting realistic goals, keeping food diaries, learning to identify and control internal and environmental cues to overeating, and learning appropriate assertiveness to cope with social situations involving eating.

Increased Physical Activity

Recent research suggests that increased aerobic exercise may reduce blood pressure in some individuals with high blood pressure. Simple, moderate intensity exercise, such as brisk walking for 30 to 60 minutes several days per week, can be beneficial for many sedentary patients. Increased activity is also important as an aid to weight control efforts. People with high blood pressure or other cardiovascular disease risk factors should consult their physicians before beginning any type of exercise program. Behavioral techniques, such as activity diaries and goal-setting, can help people to make the many changes required to integrate a program of regular exercise into their lifestyles.

Reduced Alcohol Intake

Heavy drinkers (people who consume an average of three or more drinks per day) may have elevated blood pressure or other health problems even if they have never had a problem with alcohol. Several studies have indicated that when heavy drinkers reduce their alcohol intake their blood pressure goes down. Behavior therapists have designed programs for such individuals to help them identify the situations in which they tend to drink too much and to successfully reduce their drinking. Individuals who cannot limit their drinking may need assistance in becoming and remaining abstinent.

Reducing Salt Intake

Some people with high blood pressure, including those who are taking certain types of medications, can benefit by reducing the amount of salt in their diets. Specific dietary instructions are usually provided by a professional dietitian, but behavioral techniques similar to those used in weight reduction can help individuals successfully adopt and maintain the new diet requirements. An increasing number of food products are available with reduced sodium, but specific information should be checked on food packaging. Eating out, especially at fast-food shops, where salt is a major ingredient, can make food planning necessary to keep sodium intake to acceptable levels. It is also important to note that most salt we eat doesn’t come from the salt shaker, it’s in the packaged and prepared foods at the store and in the foods served in restaurants, especially fast-food restaurants. Because it can be difficult to judge how much sodium is in the diet, it may be very helpful to ask the health care provider to help.

Stress Management

Relaxation and biofeedback techniques have been used for the treatment of hypertension for about 20 years. Although stress may contribute to the perpetuation of hypertension in some people, improved stress management may not be enough to lower blood pressure once it has become chronically elevated. Hypertension and high normal blood pressure patients who would like to try to lower their blood pressure with stress management training should, as with all the behavioral treatments, be prepared to begin, maintain, or resume drug therapy in conjunction with the behavioral techniques, if the behavioral treatments alone do not lower the blood pressure to a safe level.

Combination Treatments

A healthier life-style approach to preventing and treating hypertension might include a combination of two or more of the approaches described above. Increasing physical activity, losing weight, and limiting alcohol intake may also help reduce the risk of certain other diseases, including cardiovascular problems, diabetes, and cirrhosis.

Summary

Several life-style modification approaches have been found to benefit people with diagnosed hypertension and to help prevent the progression of high normal blood pressure to hypertension. People who wish to use these treatments for blood pressure control should work with a health care professional with training and experience in the behavioral approach(es) being attempted. They should also remain under the care of a physician, ideally one who is familiar with how behavioral approaches can best be used with and without medications. Although the behavioral treatments require greater effort than taking medications alone, they can contribute to lower blood pressure, an overall healthier life-style, and reduced risks for heart and lung disease, liver disease, and diabetes.

 

For more information or to find a therapist:

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Association for Behavioral and Cognitive Therapies
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