Adults with Asthma

Manual-based Self-administered Asthma Intervention

Article Citation:
Hockemeyer J, Smyth J. Evaluating the feasibility and efficacy of a self-administered manual-based stress management intervention for individuals with asthma: Results from a controlled study. Behavioral Medicine 2002;27(4):161-73.

Intervention Setting:
Self-administration at participants’ residences

Target Population:
Adults with asthma

Program Description:
Stress may be especially harmful for individuals with chronic illnesses because pre-existing physiologic and psychologic vulnerabilities may increase their chances of suffering from the ill effects of stress. Stress management interventions (e.g. cognitive restructuring and relaxation training) are effective for persons with cancer, with HIV and diabetes. In this study, the researchers developed and examined the feasibility and effectiveness of combining these forms of stress management into a complementary, self-administered, manual-based intervention for adults who have asthma. There were three treatment components: relaxation training, written emotional expression, and cognitive-behavioral therapy (CBT). The hypotheses to be tested were 1) objective measures of lung function would be significantly improved and 2) perceived stress level would be lower at the end of the 4-week intervention. Participants attended an initial session for baseline data collection that included demographic information, an assessment of overall health during the previous month, and spirometry. Participants then took a perceived stress scale evaluation, a 14-item scale that assessed the degree to which participants perceived as stressful the events or circumstances in their lives in the previous 30 days.

Upon completion of the pretest assessments, all participants performed the workbook intervention for 4 weeks. The treatment condition workbook had three components: a tape-recorded deep-breathing relaxation exercise, a CBT, and a 20 minute exercise in which participants wrote about a stressful life event. The cognitive behavioral treatment exercises in the treatment book included a one-to-two-page reading each week to help participants become aware of their thoughts, feelings, and emotions about stressful experiences. Each week’s reading had a corresponding application on which participants were to work for 30 minutes. The applications focused on recording thoughts and completing cognitive restructuring exercises. The 20-minute writing exercises were integrated into the treatment workbook to complement the cognitive behavioral treatment exercises for each of the 4 weeks. The placebo-control workbook contained audiotapes about asthma education, problem-solving exercises, and personal time management plans. Full compliance with the intervention also required each group to listen to either a relaxation or asthma education audiotape at least 3 times each week: once immediately before they engaged in the exercises, once after finishing their weekly writing exercise, and once at a time of their own choosing. Four weeks later, upon completion of the manual, participants returned to the laboratory to complete follow-up assessments.

Evaluation Design:
A controlled, prospective experimental design that randomly assigned adults with asthma to a treatment or control group was used.

Sample Size:
The sample included 60 college students aged 18–51 years from undergraduate psychology classes and from the general campus community at a midwestern university.

Outcome Measures and Results:
The primary outcome was lung function as measured by forced expiratory volume in 1 second (FEV1) and FEV1 divided by the forced vital capacity (FVC) with the ratio expressed as a percentage (FEV1%). Participants in the treatment group had better lung function at follow-up than did the placebo group. Covariate adjusted estimated group differences were 6.1% higher FEV1 and 5.7% higher FEV1 % at follow-up among those in the treatment group. For participants who completed the entire 4-week workbook intervention, the covariate-adjusted estimated group differences were 6.6% higher FEV1 and 6.9% higher FEV1% at follow-up. The treatment workbook exercise did not reduce stress levels more than the placebo workbook as hypothesized. Seventy-eight percent of the treatment group participants and 74% of the placebo group reported perfect compliance with the assignment.

Availability of Protocol and Materials:
The manual used to conduct this intervention is being revised for use in a larger study and is not available for widespread distribution.

Case Study:
None